Surgical treatment of drug-resistant epilepsy, University Hospital of Strasbourg

Summary Objective Surgical treatment of drug-resistant epilepsy is the last resort to reduce or completely cure epilepsy. The objectives of this study were firstly, to study the different profiles and postoperative complications for patients managed at our institution and also to estimate the cost of explorative study by stereoelectroencephalographic electrodes (SEEG). Method A retrospective study was conducted on patients operated between 2003 and 2008 and followed by the Neurology Department. Results A total of 104 medical records were analyzed. The average patient age at surgery was 34 years (range 10–70 years) and mean duration of epilepsy before surgery 21 years (range: 3–56 years). In 80% of cases, type temporal epilepsy was encountered, mainly treated by temporal resection (72%). One year after surgery, 60% of patients were seizure-free(Engel class I), 62% of the patients could resume their work or school and 26% of patients had permanent postoperative complications, minor and expected in the majority of them; no deaths have been reported. Discussion/conclusion Two types of medical devices are used in the management of epilepsy surgery: the left vagus nerve stimulation (8900 € paid besides hospital benefits) and the electrodes of stereo-electroencephalography (SEEG) in possible prior to conventional surgery. Having introduced the use of SEEG electrodes in our institution in 2004, for epilepsy surgery an average of 11 electrodes (eight to 15 electrodes) is required at an average cost of € 4284 per patient. These electrodes represent 58% of average tariff, of the disease-related groups found among patients (€ 7418). In our study, epilepsy surgery appears to be of significant clinical benefit. However, the cost-effectiveness of conventional surgery for epilepsy post-SEEG must be reevaluated to confirm the long-term interest.