Table of Contents
Epilepsy Research and Treatment
Volume 2015, Article ID 675071, 10 pages
Review Article

Bridging the Gap between Evidence and Practice for Adults with Medically Refractory Temporal Lobe Epilepsy: Is a Change in Funding Policy Needed to Stimulate a Shift in Practice?

1Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
2Toronto Western Hospital, University Health Network, Toronto, ON, Canada M5T 2S8
3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8P 1H1
4Division of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
5Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
6Division of Fundamental Neurobiology, Toronto Western Research Institute, Toronto Western Hospital, Toronto, ON, Canada M5T 2S8
7Krembil Neuroscience Center, Toronto, Canada

Received 17 October 2015; Accepted 11 November 2015

Academic Editor: József Janszky

Copyright © 2015 Alireza Mansouri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Surgery for medically refractory epilepsy (MRE) in adults has been shown to be effective but underutilized. Comprehensive health economic evaluations of surgery compared with continued medical management are limited. Policy changes may be necessary to influence practice shift. Methods. A critical review of the literature on health economic analyses for adults with MRE was conducted. The MEDLINE, EMBASE, CENTRAL, CRD, and EconLit databases were searched using relevant subject headings and keywords pertaining to adults, epilepsy, and health economic evaluations. The screening was conducted independently and in duplicate. Results. Four studies were identified (1 Canadian, 2 American, and 1 French). Two were cost-utility analyses and 2 were cost-effectiveness evaluations. Only one was conducted after the effectiveness of surgery was established through a randomized trial. All suggested surgery to be favorable in the medium to long term (7-8 years and beyond). The reduction of medication use was the major cost-saving parameter in favor of surgery. Conclusions. Although updated evaluations that are more generalizable across settings are necessary, surgery appears to be a favorable option from a health economic perspective. Given the limited success of knowledge translation endeavours, funder-level policy changes such as quality-based purchasing may be necessary to induce a shift in practice.