OBJECTIVES

Approximately 30-40%¹ of epilepsy patients are refractory to available medications, and may be candidates for resective surgery, which can be an effective treatment option. As a result, there is an increasing number of epilepsy surgery evaluations. However, the success of such surgery is heavily dependent on identifying the area of seizure origin (foci). In particular, complex, non-lesional epilepsy foci are often the most difficult to locate and thus, have the lowest seizure freedom rate of 27-35%^2,3. This study aims to determine the effectiveness and budget impact of electroencephalogram (EEG) electric source imaging (ESI) as a tool to aid surgical resection planning for complex, non-lesional patients.

METHODS

A recent Swiss study⁴ found that ESI’s 3D patient-specific source localisation and spike detection improved surgical decision-making and added diagnostic value over standard practice. The study showed that seizure freedom from using ESI was >50% in non-lesional patients, and 86% across all epilepsy surgeries. We developed an Excel-based health economic model to extrapolate the effects of both ESI and standard imaging techniques to the annual number of epilepsy surgeries in an illustrative hospital. A literature review was conducted to source additional inputs to estimate the budget impact of ESI to a hospital with respect to the cost of surgeries, subsequent hospitalisations and repeat surgeries.

RESULTS

Assuming ESI achieves a seizure freedom rate of 50% vs 35% for current standard practice, a hospital with 150 complex non-lesional epilepsy surgeries per year could have approximately 22 more seizure-free patients and 2 fewer repeat surgeries. The reduced hospitalisations from more seizure-free patients and fewer repeat surgeries could save the hospital upwards of €14,000 a year using publicly-available costs.

CONCLUSIONS

Implementation of ESI as an evaluation tool for epilepsy surgery can reduce the overall health economic burden of epilepsy and epilepsy surgery.