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Updated: Jul 10, 2025
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Clinician views regarding early surgery for paediatric epilepsy
Omar Salim1, Aswin Chari2, Ido Ben Zvi3
1School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Insights
Most UK clinicians support early epilepsy surgery for children, prioritizing seizure freedom and quality of life. Early referral for presurgical evaluation is common, especially for younger children or those with visible lesions.
Area of Science:
- Pediatric Neurology
- Epilepsy Surgery
- Clinical Trial Design
Background:
- Drug-resistant lesional epilepsies in children often necessitate surgical referral.
- Early surgical intervention may improve cognitive outcomes by reducing brain exposure to uncontrolled seizures.
- Designing trials for early surgery requires understanding specialist clinician perspectives on feasibility and outcomes.
Purpose of the Study:
- To investigate UK specialist clinician views on the feasibility and measurable outcomes for a trial comparing early epilepsy surgery with standard care.
- To gather input for designing a clinical trial for expedited surgical intervention in pediatric lesional epilepsies.
Main Methods:
- Online surveys were distributed to 51 UK clinicians (pediatricians, neurologists, epilepsy nurses) via regional networks and professional societies (June-July 2022).
- The survey assessed views on candidacy for epilepsy surgery, outcome measures, and support for a proposed early surgery trial.
- Pearson's chi-squared tests were used to compare clinician views by specialty.
Main Results:
- 76-98% of clinicians would refer children for presurgical evaluation at or before drug resistance development.
- 73% would consider early surgery before drug resistance is established, with seizure freedom (39%) and quality of life (22%) as top outcomes.
- Earlier referral was more commonly considered for children under two years (31%) or those with detectable lesions (53%).
Conclusions:
- Clinician opinions largely align with current epilepsy surgery referral guidelines.
- Most clinicians support early surgical intervention in appropriate pediatric epilepsy cases, emphasizing seizure control and quality of life.
- Incorporating these clinician perspectives is crucial for successful future trial design, recruitment, and clinical utility in pediatric epilepsy surgery.
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.
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