Chirurgie des 茅pilepsies de l鈥檈nfant聽: du fonctionnement en r茅seau 脿 la cr茅ation d鈥檜n centre d鈥檈xpertise et de soins

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• 作者：A. Arzimanoglou^a ; ^b ; ^{alexis.arzimanoglou@rdb.aphp.fr} ; M. Bourgeois^c ; P. Kahane^d ; E. Hirsch^e ; N. Boddaert^f ; P. Ryvlin^g ; C. Sainte-Rose^c
• 关键词：Epilepsy surgery ; Epilepsy center ; Childhood epilepsy
• 刊名：Neurochirurgie
• 出版年：2008
• 期刊代码：pca376_00283770
• 类别：neu
• 出版时间：May 2008
• 卷：54
• 期：3
• 页码：479-483
• 文件大小：117 K

摘要

We report on the experience of a network created in 1994 to evaluate children with drug-resistant epilepsies who are candidates for surgical treatment. The network includes epilepsy units from several university hospitals in France that decided to share not only their clinical expertise to better respond to the need for a multidisciplinary approach of epilepsy surgery in children, but also all the technical and human resources available in the various teams. This mode of operation has certainly provided concrete proof of its efficacy since it undoubtedly facilitated, and even accelerated, access to optimal presurgical evaluation and epilepsy surgery for hundreds of children. However, after 10 years of this very enriching practice it became evident that our approach was certainly necessary but not sufficient. It is estimated that every year in France nearly 500 children are candidates for surgical treatment, and following a presurgical evaluation, 50%of them could be operated on. Today, only 150鈥?00 children have access to a presurgical evaluation every year. This is a highly paradoxical situation since, even if the human suffering component that such a situation generates is set aside, the direct and indirect life-time costs for every 100 nonoperated patients is estimated at 40 million euros.

As a result of our cumulated experience, in 2004 we proposed a different operating model with the creation of an expertise center that will combine not only medical care services provided by a fully equipped multidisciplinary team, but also a pole of applied clinical and fundamental research, a medicosocial center managed by a lay association and an industrial development pole. The project has been recently validated by the Ministry of Health and is supported by a number of national and regional institutions. The Institute for Children and Adolescents with Epilepsy 鈥?IDEE 鈥?is designed to accelerate diagnostic procedures and, when indicated, access to optimal presurgical evaluation, while also serving as a model for a medical and economic evaluation of epilepsy care in children.