Abstracts

Rationale: Surgery is a common treatment for medically intractable epilepsy. A standard part of the pre-surgical work up is review and discussion of all clinical patient variables in a multi-disciplinary clinical conference to identify the surgical intervention that will optimize clinical outcomes for each patient. Conferences involve achieving consensus between adult and pediatric neurologists, neurosurgeons, neuroradiologists and neuropsychologists, who may or may not have direct knowledge of the patient. Each provider brings a different clinical perspective to the consensus discussion that may alter their judgement of the treatment that will provide optimal outcome. This project aimed to understand how divergent perspectives may impact prediction of outcomes.


Methods: A Qualtrics survey was distributed to every participant in weekly multi-disciplinary epilepsy surgery conferences after each patient presentation. The aim of the survey was to gauge each respondent’s impression of the efficacy of the proposed intervention plan. Frequencies were run on respondent characteristics and predicted clinical outcomes. Chi-square analyses were used to examine variability in predicted Engel score outcome based on various survey respondent characteristics.


Results: A total of 1467 surveys were completed on 161 patients. Patients were 58% pediatric and 42% adult. Survey respondent characteristics and clinical outcome predictions are listed in Table 1. Rates of Engel outcome predictions varied significantly on the basis of respondent specialty, x²(8, 914)=30.13, p=< .001, primary patient population x²(4, 914)=67.56, p=< .001, and years of practice, x²(8,14)=24.27, p=.002, but not on prior clinical relationship with patient, x²(2, 914)=1.42, x=0.49. These differences were primarily driven by differences in rates of Engel IV outcome predictions, although Engel IV outcome was predicted least often. Respondents most often predicting Engel IV outcomes included: Neurologists and Neurosurgeons; pediatric and lifespan providers; and those practicing 0-5 or 16-20 years. When predicted outcomes were limited to Engel I-II or Engel III-IV, predicted outcome rates only varied significantly by respondent specialty, x²(4, 914)=10.92, p=0.03.


Conclusions: Predicted Engel outcome scores from surgical options discussed in a multi-disciplinary epilepsy surgery conference varied significantly by respondent specialty, years of practice and primary patient population. Most notably, neurologists and neurosurgeons, providers in practice 0-5 and 16-20 years, and pediatric or lifespan providers predicted Engel IV outcomes more than other respondents. These data indicate that although consensus about procedures is reached in conference, there still may be variability in perceived benefit of proposed procedures. Differences in perceived outcomes may have implications for patient/family counseling. Future examination of correspondence of predicted outcomes to actual patient outcomes is needed to best appreciate this significance.

Funding: None