We adapted and tested  the toll developed by Jette et al. (Neurology® 2012;79:1084–1093) to determine the percentage of patients that we have in our center that should be evaluated for epilepsy surgery. This is a pilot study to be implemented in large scale in Brazil.

There is a significant delay in identifying patients with refractory epilepsy who might benefit from an epilepsy surgery evaluation in most medical centers. Considering this, Jette et al. (Neurology® 2012;79:1084–1093) developed and implemented an online tool to determine appropriateness for epilepsy surgery evaluation. This tool needs to be tested and implemented in other scenarios.

We used Jette’s tool to determine appropriateness of epilepsy surgery in a cohort of 211 patients with focal epilepsy selected from an outpatient clinic of a large tertiary public university hospital in Brazil.

From 211 consecutive patients, 103 (48.8%) women and 108 (51.2%) men, with mean age of 41.3 ±15.8. Two hundred patients (94.8%) presented focal seizures with impaired consciousness. One hundred and fifty nine (75.4%) patients were using two or more antiepileptic drugs. One hundred eighty five (87.7%) patient showed abnormal electroencephalography (EEG) and 125 (59.2%) showed abnormal neuroimaging with focal lesions. All patients included in this study were in our program for one year or longer. Using the online classification tool, 91 (43.1%) patients were classified as patients that were not in need to be referred for epilepsy surgery evaluation, 19 (9%) patients should be considered for an epilepsy surgery evaluation and 101 (47.9%) patients had clear indication for epilepsy surgical evaluation. When evaluated together, the more important isolate variable for indicating a patient for epilepsy surgery evaluation was pharmacological refractoriness.

The tool developed by Jette et al. could be adapted and used at national level to improve public healthcare, offering better treatment for patients with epilepsy in Brazil.