Clinician views regarding early surgery for paediatric epilepsy

Omar Salim; Aswin Chari; Ido Ben Zvi; Rachel Batchelor; Torsten Baldeweg; J Helen Cross; Martin Tisdall

doi:10.1016/j.seizure.2023.11.011

Clinician views regarding early surgery for paediatric epilepsy

Seizure. 2023 Dec:113:80-85. doi: 10.1016/j.seizure.2023.11.011. Epub 2023 Nov 20.

Authors

Omar Salim¹, Aswin Chari², Ido Ben Zvi³, Rachel Batchelor⁴, Torsten Baldeweg⁵, J Helen Cross⁶, Martin Tisdall⁷

Affiliations

¹ School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
² Department of Neurosurgery, Great Ormond Street Hospital, London, UK; Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK. Electronic address: aswin.chari.18@ucl.ac.uk.
³ Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
⁴ Department of Psychology, Royal Holloway, University of London, London, UK.
⁵ Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.
⁶ Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK; Department of Neurology, Great Ormond Street Hospital, London, UK.
⁷ Department of Neurosurgery, Great Ormond Street Hospital, London, UK; Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.

PMID: 38000223
DOI: 10.1016/j.seizure.2023.11.011

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Significance: 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.

Keywords: Clinician; Epilepsy surgery; Paediatric; Priorities; Treatment resistance.

MeSH terms

Brain
Child
Child, Preschool
Epilepsy* / diagnosis
Epilepsy* / surgery
Humans
Quality of Life*
Seizures
Treatment Outcome