Clinician views regarding early surgery for paediatric epilepsy

• Published in: Seizure (London, England) England), 2023-12, Vol.113, p.80-85
• Main Authors: Salim, Omar, Chari, Aswin, Zvi, Ido Ben, Batchelor, Rachel, Baldeweg, Torsten, Helen Cross, J., Tisdall, Martin
• Format: Article
• Language: English
• Subjects: Brain; Child; Child, Preschool; Clinician; Epilepsy - diagnosis; Epilepsy - surgery; Humans; Paediatric; Priorities; Quality of Life; Seizures; Treatment Outcome; Treatment resistance
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2023.11.011

•Clinician survey of 51 UK-based clinicians working with children with epilepsy.•76–98 % of clinicians would refer children for presurgical evaluation at/before drug resistance development, in keeping with NICE and ILAE guidance.•Referral at/before epilepsy diagnosis was considered mostly in those with visible lesions (53 %) and those under two years (31 %).•Almost two-thirds (73 %) would consider early surgery before drug resistance is established.•Top outcomes to measure in an early surgery trial were seizure freedom (39 %) and quality of life (22 %). Many children with lesional epilepsies progress to drug resistance, a criterion required for surgical referral. Expedited surgery may reduce exposure of the developing brain to uncontrolled seizures, improving cognitive outcomes. Designing a trial comparing early surgery with standard care necessitates input from specialist clinicians regarding feasibility and measurable outcomes, which this study investigated. Online surveys were disseminated from June-July 2022 via regional paediatric epilepsy networks and professional societies. 51 UK clinicians responded, mostly paediatricians, paediatric neurologists and epilepsy specialist nurses. Candidacy for epilepsy surgery, outcome measures and support for the proposed study were surveyed. Clinician views were compared by speciality, using Pearson's chi-squared tests to explore differences. 76–98 % of clinicians would refer children for presurgical evaluation at/before drug resistance development across four subgroups (those younger/older than two years, and those with/without a detectable lesion). Earlier referral, at/before epilepsy diagnosis, was considered mostly in those with visible lesions (53 %) and those under two years (31 %). 73 % would consider early surgery before drug resistance is established. Top outcomes to measure were seizure freedom (39 %) and quality of life (22 %). Views of paediatric neurologists and paediatricians did not differ (p > .05). Clinician opinions generally aligned with published guidance regarding epilepsy surgery referral. Some remain cautious to refer young children with lesions prior to trialling more than one antiseizure medication. Most support early surgery in appropriate patients, with seizure and quality of life outcomes rated highly. Incorporating these perspectives will aid future trial design, recruitment and clinical utility.