Title: Surgical versus Pharmacologic Management of : Clinical and Cost-Effectiveness and Guidelines for Use

Date: 28 July 2008

Research questions:

1. What is the clinical effectiveness of surgical versus pharmacological interventions for the management of temporal lobe epilepsy in adults?

2. What is the cost effectiveness of surgical versus pharmacological interventions for the management of temporal lobe epilepsy in adults?

3. What are the guidelines for the management of temporal lobe epilepsy in adults?

Methods:

A limited literature search was conducted on key health technology assessment resources, including PubMed, the Cochrane Library (Issue 3, 2008), University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, EuroScan, international HTA agencies, and a focused Internet search. Results include articles published between 2003 and July 2008, and are limited to English language publications only. No filters were applied to limit the retrieval to study type. Internet links are provided, where available.

Results:

HTIS reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews and meta-analyses are presented first. These are followed by economic evaluations, randomized controlled trials, observational studies and evidence-based guidelines.

The literature search identified two systematic reviews/meta-analyses, one economic analysis, two randomized controlled trials, and three guidelines addressing the research questions. No

Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. HTIS responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

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health technology assessments were identified. Additional articles of potential interest are included in the appendix.

Health technology assessments No literature identified.

Systematic reviews and meta-analyses

1. Vaz SA. Nonverbal memory functioning following right anterior temporal lobectomy: a meta-analytic review. Seizure 2004;13(7):446-52. PubMed: PM15324819

2. Chapell R, Reston J, Snyder D. Management of treatment-resistant epilepsy [Evidence Report/Technology Assessment No. 77]. Rockville (MD): Agency for Healthcare Research and Quality; 2003. AHRQ Publication No 03-0028. Available: http://www.ahrq.gov/downloads/pub/evidence/pdf/trepilep/trepilepsy.pdf (accessed 2008 Jul 25). Volume 2. Evidence Tables Available: http://www.ahrq.gov/downloads/pub/evidence/pdf/trepilep/trepilepsy2.pdf (accessed 2008 Jul 25).

Economic analyses and cost information

3. Langfitt JT, Holloway RG, McDermott MP, Messing S, Sarosky K, Berg AT, et al. Health care costs decline after successful epilepsy surgery. 2007;68(16):1290-8. PubMed: PM17438219

Randomized controlled trials

4. Helmstaedter C, Van RD, Clusmann H, Urbach H, Elger CE, Schramm J. Collateral brain damage, a potential source of cognitive impairment after selective surgery for control of mesial temporal lobe epilepsy. J Neurol Neurosurg 2004;75(2):323- 6. PubMed: PM14742620

5. Lutz MT, Clusmann H, Elger CE, Schramm J, Helmstaedter C. Neuropsychological outcome after selective amygdalohippocampectomy with transsylvian versus transcortical approach: a randomized prospective clinical trial of surgery for temporal lobe epilepsy. Epilepsia 2004;45(7):809-16. PubMed: PM15230706

Guidelines and recommendations

6. Epilepsy surgery. In: Aetna.com [Clinical Policy Bulletin No 0394]. Hartford (CT): Aetna Inc.; 2008. Available: http://www.aetna.com/cpb/medical/data/300_399/0394.html (accessed 2008 Jul 25).

7. Newer drugs for epilepsy in adults. [Technology Appraisal Guidance 76]. London (UK): National Institute for Clinical Excellence. NHS; 2004. Available: http://www.nice.org.uk/nicemedia/pdf/TA076fullguidance.pdf (accessed 2008 Jul 25).

8. Engel J, Wiebe S, French J, Sperling M, Williamson P, Spencer D, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association

Management of Temporal Lobe Epilepsy 2

with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology 2003;60(4):538-47. PubMed: PM12601090. Available: http://www.neurology.org/cgi/reprint/60/4/538.pdf Summary available: http://www.guideline.gov/summary/summary.aspx?doc_id=4108&nbr=003153&string=00 3153

Prepared by: Karen Cimon, Research Assistant Emmanuel Nkansah, MLS, MA, Information Specialist Health Technology Inquiry Service Email: [email protected] Tel: 1-866-898-8439

Management of Temporal Lobe Epilepsy 3

Appendix – further information:

Health technology assessments

9. Whiting P, Gupta R, Burch J, Mota RE, Wright K, Marson A, et al. A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery. Health Technol Assess 2006;10(4):1-250, iii-iv. PubMed: PM16487454. Available: http://www.ncchta.org/execsumm/summ1004.shtml (accessed 2008 Jul 25).

Systematic reviews and meta-analyses

10. Willmann O, Wennberg R, May T, Woermann FG, Pohlmann-Eden B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure 2007;16(6):509-20. PubMed: PM17532231

11. Willmann O, Wennberg R, May T, Woermann FG, Pohlmann-Eden B. The role of 1H magnetic resonance spectroscopy in pre-operative evaluation for epilepsy surgery. A meta-analysis. Epilepsy Res 2006;71(2-3):149-58. PubMed: PM16890408

Randomized controlled trials

12. McGuire G, El-Beheiry H, Manninen P, Lozano A, Wennberg R. Activation of electrocorticographic activity with remifentanil and alfentanil during neurosurgical excision of epileptogenic focus. Br J Anaesth 2003;91(5):651-5. PubMed: PM14570785

Observational studies

13. Yasuda CL, Tedeschi H, Oliveira EL, Ribas GC, Costa AL, Cardoso TA, et al. Comparison of short-term outcome between surgical and clinical treatment in temporal lobe epilepsy: a prospective study. Seizure 2006;15(1):35-40. PubMed: PM16337144

Guidelines and recommendations

14. Karis JP, Seidenwurm DJ, Davis PC, Brunberg JA, De La Paz RL, et al. Epilepsy. Reston (VA): American College of (ACR); 2006. Available: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/Exper tPanelonNeurologicImaging/EpilepsyDoc3.aspx (accessed 2008 Jul 25). Summary available: http://www.guideline.gov/summary/summary.aspx?doc_id=10604&nbr=005546&string=0 05546 (accessed 2008 Jul 25).

Review articles

15. Berg AT. The natural history of mesial temporal lobe epilepsy. Curr Opin Neurol 2008;21(2):173-8. PubMed: PM18317276

16. Langfitt JT, Wiebe S. Early surgical treatment for epilepsy. Curr Opin Neurol 2008;21(2):179-83. PubMed: PM18317277

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17. Schramm J. Temporal lobe epilepsy surgery and the quest for optimal extent of resection: A review. Epilepsia 2008. PubMed: PM18410360

18. Kuzniecky R, Devinsky O. Surgery Insight: surgical management of epilepsy. Nat Clin Pract Neurol 2007;3(12):673-81. PubMed: PM18046440

19. Stern JM. Overview of treatment guidelines for epilepsy. Curr Treat Options Neurol 2006;8(4):280-8. PubMed: PM16942671

20. Ko DY. Temporal lobe epilepsy. In: eMedicine [database online]. New York: WebMD; 2006. Available: http://www.emedicine.com/neuro/TOPIC365.HTM (accessed 2008 Jul 25). Note: Free registration required

21. Passaro EA, Jobe KW. Identification of potential epilepsy surgery candidates. In: eMedicine [database online]. New York: WebMD; 2006. Available: http://www.emedicine.com/neuro/TOPIC506.HTM (accessed 2008 Jul 25). Note: Free registration required

22. Schmidt D, Baumgartner C, Loscher W. The chance of cure following surgery for drug- resistant temporal lobe epilepsy. What do we know and do we need to revise our expectations? Epilepsy Res 2004;60(2-3):187-201. PubMed: PM15380563

23. Wiebe S. Effectiveness and safety of epilepsy surgery: what is the evidence? CNS Spectr 2004;9(2):120-32. PubMed: PM14999168

24. Positron emission tomography (PET) for epilepsy. [MSAC reference 26]. Canberra (Australia): Commonwealth of Australia ; 2004 Nov. Available: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/ref26- 1/$FILE/msacref26.pdf (accessed 2008 Jul 25).

Additional references

25. Sadi-Pooya AA, Sperling MR. Potentiation of anti-epileptic drugs effectiveness by pyronaridine in refractory epilepsy. Med Hypotheses 2007;69(3):560-3. PubMed: PM17368747

26. Wiebe S, Jette N. Randomized trials and collaborative research in epilepsy surgery: future directions. Can J Neurol Sci 2006;33(4):365-71. PubMed: PM17168161

27. Haglund MM, Hochman DW. Furosemide and mannitol suppression of epileptic activity in the human brain. J Neurophysiol 2005;94(2):907-18. PubMed: PM15728766

28. Schmidt D, Bertram E, Ryvlin P, Luders HO. The impact of temporal lobe surgery on cure and mortality of drug-resistant epilepsy: summary of a workshop. Epilepsy Res 2003;56(2-3):83-4. PubMed: PM14642991

Management of Temporal Lobe Epilepsy 5