Abstracts

There is a delay from the onset of epilepsy to epilepsy surgery of approximately 20 years. The aim of this study was to indentify if a delay in referring patients for epilepsy sugery is attributed to different views that neurologists have for refractory epilepsy. Through a survey, we assessed neurologists[apos] definition of medically refractory epilepsy and their decision-making process on when to refer their patients for epilepsy surgery., A 10-item survey was developed and mailed to all practicing Michigan neurologists outside our institution. Surveys were anonymous but coded for tracking purposes. A nominal incentive was offered to respondents. Descriptive statistics were used in analysis., Surveys were sent to 415 neurologists, 84 neurologists responded for a response rate of 20.24%. The majority of respondents defined medically refractory epilepsy as failing 3 monotherapy antiepileptic drugs (AEDs) trials and at least 2 polytherapy trials. Nineteen percent said that all approved AEDs had to be failed before considering a patient medically refractory. The vast majority (85%) of respondents did not feel failure of a vagus nerve stimulator (VNS) was required before labeling a patient refractory. However, the majority (62%) of the respondents thought that VNS offers a [gt]10% chance of seizure-freedom. Our survey showed that 82% of the participants had referred patients for surgery and 73% of respondents felt that epilepsy surgery is under recommended overall. The majority (70%) of neurologists would not consider patients [lt]10 or [gt]60 years old as appropriate surgical candidates. The majority stated that their patients should not be considered for surgery unless seizures have been present for a minimum of two years and have a frequency of monthly or greater. Almost 50% percent of respondents were not satisfied with the level of communication from epilepsy centers, and one-third did not have their patients returned to their care in a timely fashion. Another third reported serious complications resulting from surgery., These results provide further insight into the delay seen between onset of epilepsy and time to surgery. The majority of respondents concluded that children less than 10 years of age are inappropriate surgical candidates. In addition, nearly 50% percent of respondents were not satisfied with the level of communication from epilepsy centers, and one-third did not have their patients returned in a timely fashion. Better education of neurologists, as well as better communication from comprehensive epilepsy centers could shorten the time to referral, increase the number of referrals and ultimately improve the lives of our patients., (Supported by Henry Ford Hospital Neurology Department.)