This is the current release of the guideline.

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

1. 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)
2. 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)
3. 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:

1. Primary outcome(s) is/are clearly defined.
2. Exclusion/inclusion criteria are clearly defined.
3. Adequate accounting for dropouts and crossovers with numbers sufficiently low to have minimal potential for bias.
4. 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.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2003 Feb 25

American Academy of Neurology - Medical Specialty Society
American Association of Neurological Surgeons - Medical Specialty Society
American Epilepsy Society - Disease Specific Society

The American Epilepsy Society, in collaboration with the Quality Standards Subcommittee of the American Academy of Neurology, appointed a panel to develop practice parameters for surgical treatment of epilepsy. The American Association of Neurological Surgeons subsequently agreed to join this project. The core-working group consisted of four neurologists who were directors of epilepsy centers that offered surgical treatment, a neurosurgeon who was director of an epilepsy surgery program, and a neurologist with particular expertise in outcomes research. Additional panelists included two members of the Quality Standards Subcommittee, one of whom was an epileptologist and another who was not; a neurologist who was director of an epilepsy program for a health maintenance organization; and a general neurologist.

American Academy of Neurology (AAN)

Not stated

Quality Standards Subcommittee Members: Gary Franklin, MD, MPH (Co-Chair); Catherine Zahn, MD (Co-Chair); Milton Alter, MD, PhD; Stephen Ashwal, MD; Richard M. Dubinsky, MD; Jacqueline French, MD; Michael Glantz, MD; Gary Gronseth, MD; Deborah Hirtz, MD; Robert G. Miller, MD; James Stevens, MD; and William J. Weiner, MD

Not stated

This is the current release of the guideline.

None available

This summary was completed by ECRI on February 11, 2004.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.