• Chiara Fois, Stjepana Kovac, Aytakin Khalil, Gülnur Tekgöl Uzuner, Beate Diehl, Tim Wehner, John S Duncan, and Matthew C Walker.
• UCL Institute of Neurology, UCL, London, UK Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy Jules Thorne Telemetry Unit, National Hospital for Neurology and Neurosurgery, London, UK.
• J. Neurol. Neurosurg. Psychiatr. 2016 Feb 1; 87 (2): 209-11.

ObjectivesTo define factors that predict whether patients with pharmacoresistant focal epilepsy are offered epilepsy surgery (including invasive EEG) and the main reasons for not proceeding with these after non-invasive presurgical evaluation.MethodsWe retrospectively analysed data from 612 consecutive patients with focal epilepsy admitted to a video-EEG Telemetry Unit for presurgical evaluation, and used a multivariate logistic regression model to assess the predictive value of factors for being offered potentially curative surgery.ResultsIn the multivariate analysis, bilateral lesions on MRI (OR: 0.10; 95% CI 0.03 to 0.24), no lesion (OR: 0.33; 95% CI 0.22 to 0.49) or extratemporal lobe epilepsy (OR: 0.30; 95% CI 0.20 to 0.45) were the only factors that significantly reduced the probability of being offered surgery. 32% of patients who were offered epilepsy surgery decided against proceeding.ConclusionsThere was a low chance (<10%) of being offered surgery if there were bilateral lesions on MRI and extratemporal lobe epilepsy. Patients should be given advice on the risk/benefit ratio and of realistic outcomes of epilepsy surgery; this may help reduce the number of patients who refuse surgery after comprehensive workup.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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