Abstracts

Rationale: Recently there has been attention made to published guidelines regarding the diagnosis and treatment of epilepsy. Few studies have examined the awareness of physicians and their understanding of best practices in epilepsy. This study assessed the initial diagnosis and treatment practices of physicians seeing pediatric patients with epilepsy and concordance with current guidelines. Methods: A survey was constructed to assess the familiarity that healthcare providers had with guidelines pertaining to epilepsy surgery. Information including physician age, number of years of practicing medicine, subspecialty, practice affiliation, and patient population were collected in order to see if there were any associations with guidelines. The survey was to health care providers in Central Texas whose focus is in pediatrics, family medicine, neurology/neurosurgery. Results: 146 (~10%) responded to the survey. Among respondents, 57.5% were from pediatrics, 12.6% from neurology/neurosurgery, and 29.9% family medicine. Approximately half the respondents were from private practice. Respondents were equally represented for gender with 48.2% being male. The majority were Caucasian (74%). Respondents saw a median of one (range:0-100) new cases of seizures per month and a median of 2.5 (range:0-200) pediatric patients with epilepsy per month. Approximately half the clinicians had been practicing medicine for less than 15 years. Among physicians, the definition of drug refractory epilepsy was unclear with 60% of those surveyed being unsure or disagreeing that failing 2-3 anticonvulsants constituted refractoriness. Nearly 75% agreed that referral for epilepsy surgery evaluation should be considered, if the child has intractable epilepsy. 53.5% agreed that a child should be referred after 3 years of failed AED treatment and 38% were unsure. 46.8% were unsure if a child should be referred after a failed VNS and 50% were also unsure after a failed ketogenic diet. The highest percentage of those who were unsure regarding referrals for a failed VNS and/or diet were those in family medicine. Surgery was agreed to be effective for children with partial epilepsy by 29.2% of respondents. 63.1% were unsure with family practitioners comprising the majority. 63.3% were unsure if surgery was agreed to be effective for those with generalized epilepsy and 22.7% disagreed. As for those with temporal lobe epilepsy, 64.1% were unsure whether surgery was effective and 31.3% disagreed. Family practitioners still represented the majority of those who were unsure for these types of epilepsy. More than half were unsure that surgery is related to good cognitive outcomes for those with intractable epilepsy. More than half, however, agreed that surgery is associated with quality of life improvement. Conclusions: There remains significant misinformation regarding when epilepsy surgical referrals in pediatric patients should be made. This appears to be associated with what constitutes intractable epilepsy as well as for what types of seizures may be amendable to epilepsy surgical intervention.