Long-term evaluation of anterior thalamic deep brain stimulation for epilepsy in the European MORE registry.

OBJECTIVE: Short-term outcomes of deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) were reported for people with drug-resistant focal epilepsy (PwE). Because long-term data are still scarce, the Medtronic Registry for Epilepsy (MORE) evaluated clinical routine application of ANT-DBS. METHODS: In this multicenter registry, PwE with ANT-DBS were followed up for safety, efficacy, and battery longevity. Follow-up ended after 5 years or upon study closure. Clinical characteristics and stimulation settings were compared between PwE with no benefit, improvers, and responders, that is, PwE with average monthly seizure frequency reduction rates of ≥50%. RESULTS: Of 170 eligible PwE, 104, 62, and 49 completed the 3-, 4-, and 5-year follow-up, respectively. Most discontinuations (68%) were due to planned study closure as follow-up beyond 2 years was optional. The 5-year follow-up cohort had a median seizure frequency reduction from 16 per month at baseline to 7.9 per month at 5-year follow-up (p < .001), with most-pronounced effects on focal-to-bilateral tonic-clonic seizures (n = 15, 77% reduction, p = .008). At last follow-up (median 3.5 years), 41% (69/170) of PwE were responders. Unifocal epilepsy (p = .035) and a negative history of epilepsy surgery (p = .002) were associated with larger average monthly seizure frequency reductions. Stimulation settings did not differ between response groups. In 179 implanted PwE, DBS-related adverse events (AEs, n = 225) and serious AEs (n = 75) included deterioration in epilepsy or seizure frequency/severity/type (33; 14 serious), memory/cognitive impairment (29; 3 serious), and depression (13; 4 serious). Five deaths occurred (none were ANT-DBS related). Most AEs (76.3%) manifested within the first 2 years after implantation. Activa PC depletion (n = 37) occurred on average after 45 months. SIGNIFICANCE: MORE provides further evidence for the long-term application of ANT-DBS in clinical routine practice. Although clinical benefits increased over time, side effects occurred mainly during the first 2 years. Identified outcome modifiers can help inform PwE selection and management.

Information Sources and Decision-Making in Neurosurgery: Results of a Survey of Members of the Brazilian Neurosurgery Society

Introduction In all surgical disciplines, including neurosurgery, there are questions about the level of evidence supporting surgical practices and the mechanisms and adequacy of knowledge translation. Objectives To assess the perception of Brazilian neurosurgeons of information sources and decision-making mechanisms related to their medical practices. Methods An online questionnaire was sent to the 2,400 members of the Brazilian Neurosurgical Society. Results A total of 32% of the neurosurgeons completed the questionnaire, 53% had more than 10 years experience, 67% had worked in public hospitals, 34% had performed spine surgeries, and 30% had performed brain tumor surgeries. The therapeutic decisions were based mostly on internship learning (54%) and personal professional experience (52%). The most common information sources were scientific abstracts (53%) and the Internet (47%). A total of 89% believed that evidence-based medicine was relevant, 93% believed protocols or guidelines were necessary, and 74% subscribed to a medical journal. Nonetheless, only 43% had protocols implemented in their services, 93% highly valued a surgeon's personal experience, and 63% showed little familiarity with the interpretation of scientific concepts in the literature. Among the respondents, 83% were willing to try an innovative treatment alternative if it was shown to improve clinical outcomes and reduce severe complications. Conclusions The disparity in the responses highlights the need to implement recommendations that improve decision-making mechanisms.

Introdução Em todas as disciplinas cirúrgicas, incluindo a neurocirurgia, existem questões sobre o nível de evidência que apoia as práticas cirúrgicas e os mecanismos e adequação da translação do conhecimento. Objetivos Avaliar a percepção de fontes de informação e mecanismos de tomada de decisão dos neurocirurgiões brasileiros em relação às práticas médicas. Métodos Um questionário on-line foi enviado aos 2.400 membros da Sociedade Brasileira de Neurocirurgia. Resultados Um total de 32% dos neurocirurgiões preencheram o questionário, 53% tinham mais de 10 anos de experiência, 67% trabalharam em hospitais públicos, 34% realizaram cirurgia de coluna, e 30%, de cérebro. As decisões terapêuticas basearam-se principalmente no aprendizado de estágio (54%) e na experiência profissional pessoal (52%). As fontes de informação mais comuns foram resumos científicos (53%) e a Internet (47%). Um total de 89% acreditava que a medicina baseada em evidências era relevante, 93% acreditavam que protocolos ou diretrizes eram necessários, e 74% tinham assinaturas de uma revista médica. No entanto, apenas 43% apresentaram protocolos implementados em seus serviços, 93% valorizaram a experiência pessoal de um cirurgião, e 63% mostraram pouca familiaridade com a interpretação de conceitos científicos na literatura. Entre os respondentes, 83% estavam dispostos a tentar uma alternativa de tratamento inovador se este demonstrasse melhorar os resultados clínicos e reduzir as complicações graves. Conclusões A disparidade nas respostas destaca a necessidade de implementar recomendações que melhorem os mecanismos de tomada de decisão.