Epilepsy surgery for people with a low IQ.

摘要

Epilepsy is more prevalent in people with a low IQ than the general population. Up to 1 in 4 people with epilepsy may have a learning disability, yet this group are often under-represented in specialist neurology services. This study examined access and outcomes in epilepsy surgery for people with a low IQ in an audit of 953 patients who have undergone pre-surgical evaluation in our service from 1988 to 2007. We noted a significant increase in the proportion of people with an IQ of 70 or less who have been evaluated for surgery since the routine introduction of high resolution MRI. However candidates with an IQ of 70 or less remain significantly less likely to proceed to surgery; with only 1 in 4 offered surgery compared to 1 in 2 of the candidates with an IQ greater than 70. People with a low IQ who proceeded to surgery achieved comparable postoperative seizure control to their counterparts with an IQ greater than 70. Our findings suggest that special consideration should be given to candidates who are excluded from surgery primarily on the basis of neuropsychological data, since the necessary specialist protocols and appropriate neuropsychological test norms are not widely available for this population.