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Anti-seizure medication treatment trials prior to pre-surgical evaluation

PURPOSE: Our study evaluates patterns of anti-seizure medication (ASM) usage prior to pre-surgical evaluation in drug resistant epilepsy (DRE). METHODS: We conducted a retrospective study of patients with DRE presenting for pre-surgical evaluation from 1/1/2017 to 12/31/2018. We abstracted demograph...

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Autores principales: Pandya, Vishal, Bauer, Patrick, Thompson, Serena, Anderson, Christopher T., Raghavan, Manoj, Carlson, Chad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474306/
https://www.ncbi.nlm.nih.gov/pubmed/36119947
http://dx.doi.org/10.1016/j.ebr.2022.100565
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author Pandya, Vishal
Bauer, Patrick
Thompson, Serena
Anderson, Christopher T.
Raghavan, Manoj
Carlson, Chad
author_facet Pandya, Vishal
Bauer, Patrick
Thompson, Serena
Anderson, Christopher T.
Raghavan, Manoj
Carlson, Chad
author_sort Pandya, Vishal
collection PubMed
description PURPOSE: Our study evaluates patterns of anti-seizure medication (ASM) usage prior to pre-surgical evaluation in drug resistant epilepsy (DRE). METHODS: We conducted a retrospective study of patients with DRE presenting for pre-surgical evaluation from 1/1/2017 to 12/31/2018. We abstracted demographic data, ASM usage, MRI and EEG findings, and distance from home to our center. RESULTS: In total, 54 patients (23 female) were included. The mean number of ASM trials at the time of pre-surgical evaluation was 5.62 (±3.3; range 1–15). A mean of 0.4 ASMs (±1.1; range 0–6) were initiated at our center prior to pre-surgical evaluation. MRI localization to regions other than the hippocampal or temporal region (p = 0.002) was associated with higher numbers of ASM trials. A trend for a larger number of ASM trials was seen for increased distance of patient primary residence from our center, right-sided ictal EEG laterality, and posterior quadrant or non-localized ictal EEG patterns. CONCLUSIONS: Only 17% of patients were referred for pre-surgical evaluation after a trial of 1–2 ASMs. On average, patients tried 5.6 different ASMs with most of those trials predating referral to our center. Temporal lobe lesions were associated with fewer ASM trials prior to referral. Female sex was associated with an average of two more ASM trials than males. Our data do not allow us to determine how access to care, patient choice, and physician opinions impact the variability of ASM trials prior to referral for surgical evaluation. Our data indicate that delays to pre-surgical evaluation continue to occur.
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spelling pubmed-94743062022-09-16 Anti-seizure medication treatment trials prior to pre-surgical evaluation Pandya, Vishal Bauer, Patrick Thompson, Serena Anderson, Christopher T. Raghavan, Manoj Carlson, Chad Epilepsy Behav Rep Article PURPOSE: Our study evaluates patterns of anti-seizure medication (ASM) usage prior to pre-surgical evaluation in drug resistant epilepsy (DRE). METHODS: We conducted a retrospective study of patients with DRE presenting for pre-surgical evaluation from 1/1/2017 to 12/31/2018. We abstracted demographic data, ASM usage, MRI and EEG findings, and distance from home to our center. RESULTS: In total, 54 patients (23 female) were included. The mean number of ASM trials at the time of pre-surgical evaluation was 5.62 (±3.3; range 1–15). A mean of 0.4 ASMs (±1.1; range 0–6) were initiated at our center prior to pre-surgical evaluation. MRI localization to regions other than the hippocampal or temporal region (p = 0.002) was associated with higher numbers of ASM trials. A trend for a larger number of ASM trials was seen for increased distance of patient primary residence from our center, right-sided ictal EEG laterality, and posterior quadrant or non-localized ictal EEG patterns. CONCLUSIONS: Only 17% of patients were referred for pre-surgical evaluation after a trial of 1–2 ASMs. On average, patients tried 5.6 different ASMs with most of those trials predating referral to our center. Temporal lobe lesions were associated with fewer ASM trials prior to referral. Female sex was associated with an average of two more ASM trials than males. Our data do not allow us to determine how access to care, patient choice, and physician opinions impact the variability of ASM trials prior to referral for surgical evaluation. Our data indicate that delays to pre-surgical evaluation continue to occur. Elsevier 2022-09-06 /pmc/articles/PMC9474306/ /pubmed/36119947 http://dx.doi.org/10.1016/j.ebr.2022.100565 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Pandya, Vishal
Bauer, Patrick
Thompson, Serena
Anderson, Christopher T.
Raghavan, Manoj
Carlson, Chad
Anti-seizure medication treatment trials prior to pre-surgical evaluation
title Anti-seizure medication treatment trials prior to pre-surgical evaluation
title_full Anti-seizure medication treatment trials prior to pre-surgical evaluation
title_fullStr Anti-seizure medication treatment trials prior to pre-surgical evaluation
title_full_unstemmed Anti-seizure medication treatment trials prior to pre-surgical evaluation
title_short Anti-seizure medication treatment trials prior to pre-surgical evaluation
title_sort anti-seizure medication treatment trials prior to pre-surgical evaluation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474306/
https://www.ncbi.nlm.nih.gov/pubmed/36119947
http://dx.doi.org/10.1016/j.ebr.2022.100565
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