Definitions of the recommendation ratings (A, B, C, U) and classifications of the evidence (Class I through Class IV) are provided at the end of the "Major Recommendations" field.
Recommendations
- Patients with disabling complex partial seizures, with or without secondarily generalized seizures, who have failed appropriate trials of first-line antiepileptic drugs should be considered for referral to an epilepsy surgery center, although criteria for failure of drug treatment have not been definitely established (A)
- Patients referred to an epilepsy surgery center for the reasons stated above who meet established criteria for an anteromesial temporal lobe resection and who accept the risks and benefits of this procedure, as opposed to continuing pharmacotherapy, should be offered surgical treatment. (A)
- There is insufficient evidence at this time to make a definitive recommendation as to whether patients with a localized neocortical epileptogenic region will benefit or not benefit from surgical resection. (U)
Definitions:
Rating of Recommendation
A = established as useful/predictive or not useful/predictive for the given condition in the specified population.
B = probably useful/predictive or not useful/predictive for the given condition in the specified population.
C = possibly useful/predictive or not useful/predictive for the given condition in the specified population.
U = data inadequate or conflicting. Given current knowledge, test/predictor is unproven.
Classification Scheme for a Therapeutic Article
Class I: Prospective, randomized, controlled clinical trial with masked outcome assessment, in a representative population.
The following are required:
- Primary outcome(s) is/are clearly defined.
- Exclusion/inclusion criteria are clearly defined.
- Adequate accounting for dropouts and crossovers with numbers sufficiently low to have minimal potential for bias.
- Relevant baseline characteristics are presented and substantially equivalent among treatments groups or there is appropriate statistical adjustment for differences.
Class II: Prospective matched group cohort study in a representative population with masked outcome assessment that meets a-d above OR a randomized, controlled trial in a representative population that lacks one criterion a-d.
Class III: All other controlled trials (including well-defined natural history controls or patients serving as own controls) in a representative population, where outcome assessment is independent of patient treatment.
Class IV: Evidence from uncontrolled studies, case series, case reports, or expert opinion.