A survey of adult and pediatric epilepsy surgery in the United Kingdom.

All consultant epilepsy neurosurgeons were asked to prospectively record all epilepsy surgery procedures carried out at their center between April 2010 and March 2011. Figures were compared to a previous survey completed in 2000. Of a total of 710 procedures, temporal lobe surgery was the most common resective surgery. Although extratemporal lesional surgery was less common, vagus nerve stimulator (VNS) implantation accounted for almost half the procedures. The numbers for all surgical procedures, with the exception of VNS implantations, had decreased. This decrease may represent a global rather than a regional phenomenon. Further longitudinal multinational data on epilepsy surgery is required to confirm or refute this theory.

A prospective study of the requirement for and the provision of epilepsy surgery in the United Kingdom.

PURPOSE: Of the 30,000 persons in whom epilepsy develops annually in the United Kingdom, in approximately 6000 (20%), intractability develops. Some of these patients will be appropriate for epilepsy surgery. We aimed to estimate the number of patients who should be considered surgical candidates, by extrapolation from a population-based study of prognosis and the number who are receiving epilepsy surgery, by a survey of U.K. neurosurgeons. METHODS: We identified the number of patients who may eventually require surgery from a prospective cohort of patients with newly diagnosed epilepsy. We identified all U.K. neurosurgeons who had performed any epilepsy surgery in the past year. Each identified surgeon prospectively recorded the number and types of operations carried out for 6 months. RESULTS: Of newly diagnosed patients each year, 450 (1.5%) may eventually require surgery. Thirty-two respondents (22% of all U.K. neurosurgeons) reported that they performed epilepsy surgery. The 211 operations were carried out in the 6 months surveyed (422 operations annually or 13 per surgeon per year). Temporal lobe resection (77%) was the most common procedure. CONCLUSIONS: Based on a prevalence of 5/1,000 persons with epilepsy, < or =4,500 patients in the U.K. require epilepsy surgery. Every year, 450 patients with newly diagnosed epilepsy who may eventually require surgery are added to this "surgical pool." At the current annual rate of operations, a large number of refractory patients remain untreated. This is probably partly because many patients are not referred for specialist care and therefore remain underinvestigated.