{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:10:39Z","timestamp":1787314239192,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:00:00Z","timestamp":1675382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The evaluation to determine candidacy and treatment for epilepsy surgery in persons with drug\u2010resistant epilepsy (DRE) is not uniform. Many non\u2010invasive and invasive tests are available to ascertain an appropriate treatment strategy. This study examines expert response to clinical vignettes of magnetic resonance imaging (MRI)\u2013positive lesional focal cortical dysplasia in both temporal and extratemporal epilepsy to identify associations in evaluations and treatment choice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed annual report data and a supplemental epilepsy practice survey reported in 2020 from 206 adult and 136 pediatric epilepsy center directors in the United States. Non\u2010invasive and invasive testing and surgical treatment strategies were compiled for the two scenarios. We used chi\u2010square tests to compare testing utilization between the two scenarios. Multivariable logistic regression modeling was performed to assess associations between variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The supplemental survey response rate was 100% with 342 responses included in the analyses. Differing testing and treatment approaches were noted between the temporal and extratemporal scenarios such as chronic invasive monitoring selected in 60% of the temporal scenario versus 93% of the extratemporal scenario. Open resection was the most common treatment choice; however, overall treatment choices varied significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). Associations between non\u2010invasive testing, invasive testing, and treatment choices were present in both scenarios. For example, in the temporal scenario stereo\u2010electroencephalography (SEEG) was more commonly associated with fluorodeoxyglucose\u2013positron emission tomography (FDG\u2010PET) (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.06\u20133.29;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.033), magnetoencephalography (MEG) (OR 2.90; 95% CI 1.60\u20135.28;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0&lt;.001), high density (HD) EEG (OR 2.80; 95% CI 1.27\u20136.24;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.011), functional MRI (fMRI) (OR 2.17; 95% CI 1.19\u20134.10;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.014), and Wada (OR 2.16; 95% CI 1.28\u20133.66;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.004). In the extratemporal scenario, choosing SEEG was associated with increased odds of neuromodulation over open resection (OR 3.13; 95% CI 1.24\u20137.89;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>In clinical vignettes of temporal and extratemporal lesional DRE, epilepsy center directors displayed varying patterns of non\u2010invasive testing, invasive testing, and treatment choices. Differences in practice underscore the need for comparative trials for the surgical management of DRE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17512","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:59:00Z","timestamp":1674089940000},"page":"821-830","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Associations between testing and treatment pathways in lesional temporal or extratemporal epilepsy: A census survey of NAEC center directors"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8352-6694","authenticated-orcid":false,"given":"Christopher W.","family":"Beatty","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Neurology Nationwide Children's Hospital and The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5551-2431","authenticated-orcid":false,"given":"Stephanie M.","family":"Ahrens","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neurology Nationwide Children's Hospital and The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen H.","family":"Arredondo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dell Medical School University of Texas at Austin  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6284-8336","authenticated-orcid":false,"given":"Anto I.","family":"Bagi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh Comprehensive Epilepsy Center (UPCEC)  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shasha","family":"Bai","sequence":"additional","affiliation":[{"name":"Pediatric Biostatistics Core Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin E.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Barrow Neurologic Institute at Phoenix Children's Hospital  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Ciliberto","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stead Family Children's Hospital University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave\u00a0F.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dell Medical School University of Texas at Austin  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4703-4342","authenticated-orcid":false,"given":"Mariah","family":"Eisner","sequence":"additional","affiliation":[{"name":"Biostatistics Resource at Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan B.","family":"Fountain","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Virginia Health Sciences Center  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9392-6608","authenticated-orcid":false,"given":"Jay R.","family":"Gavvala","sequence":"additional","affiliation":[{"name":"Department of Neurology Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1825-846X","authenticated-orcid":false,"given":"M.\u00a0S.","family":"Perry","sequence":"additional","affiliation":[{"name":"Jane and John Justin Neurosciences Center Cook Children's Medical Center  Ft Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0607-7802","authenticated-orcid":false,"given":"Kyle C.","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Division of Epilepsy Beth Israel Deaconess Medical Center and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily C.","family":"Wong\u2010Kisiel","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan T.","family":"Herman","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-6650","authenticated-orcid":false,"given":"Adam P.","family":"Ostendorf","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neurology Nationwide Children's Hospital and The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the NAEC Center Director Study 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decision\u2010making to improve patient engagement in minimally invasive hysterectomy","volume":"34","author":"McCarus SD","year":"2019","journal-title":"Surg Technol 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