The
Epilepsy Surgery Grading Scale (ESGS) is a simple method to predict the likelihood of a patient with
epilepsy proceeding to surgery and achieving seizure freedom. Usefulness of the ESGS has been confirmed in established
epilepsy centres in the United States and Belgium for adult patients with drug-resistant
focal epilepsy undergoing presurgical evaluation. However, the applicability of the ESGS has not yet been evaluated in a wider range of
epilepsy patients that may reflect the general spectrum of
epilepsy. The present study validated the ESGS in a Japanese
epilepsy centre in which admission-based comprehensive
epilepsy studies were indicated beyond presurgical evaluation. This single-centre retrospective study included adult patients with
epilepsy admitted to the
Epilepsy Monitoring Unit from 2010 to June 2019. Patients were classified as ESGS Grade 1 (most favorable), Grade 2 (intermediate), and Grade 3 (least favourable). Patients were grouped into three cohorts: all patients, patients with drug-resistant
focal epilepsy, and patients who underwent resective
epilepsy surgery. We assessed progression to surgery and seizure freedom at one year after surgery. Of the 1,158 total admissions, 670 patients met the inclusion criteria and formed the total cohort. Of these, 435 (64.9%) had drug-resistant
focal epilepsy and 78 (11.6%) proceeded to resective surgery. Overall, progression to surgery was observed in 41.3%, 16.6%, and 4.8% of patients with Grade 1, 2, and 3, respectively. In the surgical cohort, seizure freedom was observed in 85.2%, 65.2%, and 31.3% of patients with Grade 1, 2, and 3, respectively. Our results indicate that the ESGS is effective in predicting whether a patient proceeds to
epilepsy surgery and achieves seizure freedom even in the general population of
epilepsy patients, regardless of type or resistance to
antiepileptic drugs.