Taufik A Valiante MD PhD FRCS

1
Access to surgery for epilepsy

• Taufik A Valiante MD PhD FRCS
• Director, Surgical Epilepsy Program

2
Epilepsy in Toronto

• Fifty thousand with epilepsy
• Presently five thousand patients could be
  surgically cured of their epilepsy
• Less seizures Improved quality of life
• Less seizures Cost saving to society
• Up until very recently could only identify 25
  patients per year for curative surgery

3
Numbers

• 0.6 of the population has epilepsy
• 40 will have complex partial seizures (CPS)
• 50 of those with CPS will be seizure free on
  medications
• 1/3 of the other 50 who are not seizure free
  will be surgical candidates
• Therefore approximately 10 of those with
  epilepsy are surgical candidates.
• With a population of 5 million, that means there
  are approximately 5000 people in Toronto that are
  candidates for curative surgery

4
Less seizures

• Improved Quality of Life (QOL)
• Economic Saving
• Generally unpalatable to talk about this aspect
• This is unfortunately the bottom line that the
  government looks at
• It is an unavoidable reality that health must be
  discussed is the context of cost
• Direct and indirect costs
• Direct (25 of total cost)
• Curing 5000 people of their epilepsy would save
  society approximately 100 million over their
  life time
• Indirect (75 of total cost)
• Far out-weight direct costs

5
Epilepsy Monitoring Unit (EMU)

• Requires specialized equipment, dedicated beds,
  and people (physicians, neuropsychologists,
  nurses and technicians)
• Key to diagnosing patients with epilepsy
• Key to identifying those with surgically
  remediable epilepsy
• Key to optimal medical management of those with
  epilepsy

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A larger EMU is

• a step towards fulfilling the needs of those
  with epilepsy
• advancement of clinical and research instruments
  in the treatment of those with epilepsy
• long term cost saving through proven treatments
  with low cost per QALY (quality adjusted life
  year)

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The beginning
8
EMU is not only answer

• Awareness
• An individual with CPS who fails a single first
  line anti-seizure medication should be referred
  to the UHN Epilepsy Program
• Physicians should do this
• Patients should ask for this to be done
• A consistent united lobby of the government to
  improve social supports for those with epilepsy
  and those who have undergone surgery for
  epilepsy
• WHY? Because it improves quality of life AND in
  the long run it is COST SAVING!

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Summary

• Surgery is under utilized
• A bigger EMU is only one aspect of increasing
  utilization of curative surgery
• Increased physician and individual awareness of
  the need for early referral to the UHN Epilepsy
  Program
• Improved social supports for those with epilepsy
  and those that have undergone surgery for
  epilepsy
• Ultimately to move towards a model of
  regionalized comprehensive care

10
For immediate implementation

• Surgery is under utilized
• A bigger EMU is only one aspect of increasing
  utilization of curative surgery
• Increased physician and individual awareness of
  the need for early referral to the UHN Epilepsy
  Program
• Improved social supports for those with epilepsy
  and those that have undergone surgery for
  epilepsy
• Ultimately to move towards a model of
  regionalized comprehensive care