Patients with drug‐resistant epilepsy (DRE) rarely achieve seizure freedom with medical therapy alone. Despite being safe and effective for select patients with DRE, epilepsy surgery remains heavily underutilized. Multiple studies have indicated that the overall rates of surgery in patients with DRE have stagnated in recent years and may be decreasing, even when hospitalizations for epilepsy‐related problems are on the rise. Ultimately, many patients with DRE who might otherwise benefit from surgery continue to have intractable seizures, lacking access to the full spectrum of available treatment options. In this article, we review the various factors accounting for the persistent underutilization of epilepsy surgery and uncover several key themes, including the persistent knowledge gap among physicians in identifying potential surgical candidates, lack of coordinated patient care, patient misconceptions of surgery, and socioeconomic disparities impeding access to care. Moreover, factors such as the cost and complexity of the preoperative evaluation, a lack of federal resource allocation for the research of surgical therapies for epilepsy, and difficulties recruiting patients to clinical trials all contribute to this multifaceted dilemma.

中文翻译：

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解读耐药性癫痫 (DRE) 的手术治疗差距：文献综述

耐药性癫痫 (DRE) 患者仅靠药物治疗很少能实现无癫痫发作。尽管对特定的 DRE 患者是安全有效的，但癫痫手术仍未得到充分利用。多项研究表明，近年来 DRE 患者的整体手术率停滞不前，并且可能正在下降，即使因癫痫相关问题而住院的人数在增加。最终，许多原本可以从手术中受益的 DRE 患者继续出现顽固性癫痫发作，无法获得全方位的可用治疗方案。在本文中，我们回顾了导致癫痫手术持续利用不足的各种因素，并揭示了几个关键主题，包括医生在确定潜在手术候选人方面的持续知识差距，缺乏协调的患者护理、患者对手术的误解以及阻碍获得护理的社会经济差异。此外，术前评估的成本和复杂性、缺乏用于癫痫手术治疗研究的联邦资源分配以及招募患者参加临床试验的困难等因素都导致了这种多方面的困境。