Limitations of NIS Database in Evaluation of Epilepsy Surgery Morbidity and Mortality—Reply

In reply

We appreciate the positive comments and kind words of Kaiboriboon et al regarding our manuscript as “an important and timely contribution” to the literature. They raise some concerns regarding aspects of our manuscript we would like to address.

Kaiboriboon et al wonder whether our results “should perhaps have been reported as including all refractory focal epilepsies rather than just TLE and all respective epilepsy surgeries rather than just temporal lobectomies.” As we have stated in this and our previous work,^1- 3 the primary reason we chose to focus only on ATL for intractable TLE is that this specific area is one of the few for which there is class I evidence.⁴ Expanding the reach of our study beyond this area would invite legitimate questions regarding whether surgery is in fact the best treatment for refractory epilepsies of other lobes, whereas it is undeniable that ATL is optimal treatment for intractable TLE.⁴ We strongly believe that expanding the scope of our study beyond parameters established by class I evidence would have significantly decreased the impact of our work.