Surgery for Intractable Epilepsy

Surgery continues to be underutilized, despite its proven efficacy.

Physicians at Hackensack Meridian Joseph M. Sanzari Children’s Hospital are advocating for earlier referral for surgical evaluation in patients with medically refractory epilepsy (MRE). Despite its proven efficacy and safety, surgery continues to be dramatically underutilized for patients with MRE.

Several key themes have emerged, including the persistent knowledge gap among physicians to identify potential surgical candidates, the lack of coordinated patient care, patient misconceptions of surgery, and the socioeconomic disparities impeding access to care. Moreover, factors such as the cost and complexity of the preoperative evaluation, a lack of federal resource allocation for the research of surgical therapies for epilepsy, and difficulties recruiting patients to clinical trials all contribute to this multifaceted dilemma.

Multiple studies have indicated that the overall rates of surgery in patients with MRE have stagnated in recent years and may be decreasing, even when hospitalizations for epilepsy‐related problems are on the rise. Ultimately, many patients with MRE who might otherwise benefit from surgery continue to have intractable seizures, lacking access to the full spectrum of available treatment options. Luke Tomycz, M.D., pediatric neurosurgeon at Joseph M. Sanzari Children’s Hospital, participated in a critical review published in Epilepsia, entitled Deciphering the Surgical Treatment Gap for Drug Resident Epilepsy, which explores this underutilization in depth.

If surgery can be performed early in life, resulting in seizure freedom, it can lead to the most normal development possible for that individual child. Even in patients with a normal MRI, some studies have shown up to 60% seizure freedom with surgery when there is concordance of metabolic studies (PET/SPECT and EEG). Patients with drug‐resistant epilepsy (DRE) rarely achieve seizure freedom with medical therapy alone.

Joseph M. Sanzari Children’s Hospital’s multidisciplinary epilepsy program performs a high volume of pediatric epilepsy surgeries and was the first program in the state to use responsive nerve stimulation. The Children’s Hospital also offers a robust nutrition program for epilepsy patients that is proven to reduce seizures. And the hospital’s neurogenetics program helps determine genesis of epilepsy when imaging and EEGs cannot determine underlying cause.