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Journal of Pediatric Epilepsy 2020; 9(03): 097-099
DOI: 10.1055/s-0040-1714355
Case Report

Ethical Issue as the Limiting Factor for Epilepsy Surgery

Satyanarayana Gedela
1   Department of Pediatrics, Emory School of Medicine, Emory University, Atlanta, Georgia, United States
2   Division of Pediatric Neurology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Christian Korff
3   Department of Pediatrics, Genève, Switzerland
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Abstract

Epilepsy is one of the most common neurological disorders with almost one-third of these patients becoming intractable to medical treatments. For some of these patients, epilepsy surgery could be the best option. There are lot of disparities in caring of the epilepsy patients. There are multiple limitations in offering epilepsy surgery for the medically intractable epilepsy patients, resulting in almost 19 years gap from the diagnosis of intractable epilepsy to epilepsy surgery. These limitations range from patient or parental fear to lack of available resources. Sometimes we face an ethical issue being the limitation from doing the right thing for the patient. We want to share our experience with one of our patients with symptomatic medically intractable focal epilepsy from Rasmussen’s encephalitis who could not get the epilepsy surgery treatment because of an ethical issue.

Keywords

intractable epilepsy - Rasmussen's encephalitis - ethics


Publication History

Received: 11 June 2020

Accepted: 11 June 2020

Article published online:
20 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342 (05) 314-319
    CrossrefPubMedGoogle Scholar
  • 2 Intractable Epilepsy: Definition and Neurobiology Jerome Engel Epilepsia, 42(Suppl. 6):3, 2001
    PubMed
  • 3 Disparities in epilepsy: report of a systematic review by the North American Commission of the International League Against Epilepsy Jorge G. Burneo; Nathalie Jette; William Theodore; Charles Begley; Karen Parko; David J. Thurman; Samuel Wiebe for the Task Force on Disparities in Epilepsy Care, on behalf of the North American Commission of the International League Against Epilepsy Epilepsia 2009;50(10):2285–2295
    PubMed
  • 4 Varadkar S, Bien CG, Kruse CA. , et al. Rasmussen's encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol 2014; 13 (02) 195-205
    CrossrefPubMedGoogle Scholar
  • 5 Bien CG, Granata T, Antozzi C. , et al. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain 2005; 128 (Pt 3): 454-471
    CrossrefPubMedGoogle Scholar
  • 6 Jonas R, Nguyen S, Hu B. , et al. Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology 2004; 62 (10) 1712-1721
    CrossrefPubMedGoogle Scholar
  • 7 Boatman D, Freeman J, Vining E. , et al. Language recovery after left hemispherectomy in children with late-onset seizures. Ann Neurol 1999; 46 (04) 579-586
    CrossrefPubMedGoogle Scholar
  • 8 Bien CG, Elger CE, Leitner Y. , et al. Slowly progressive hemiparesis in childhood as a consequence of Rasmussen encephalitis without or with delayed-onset seizures. Eur J Neurol 2007; 14 (04) 387-390
    CrossrefPubMedGoogle Scholar