Neuropsychiatric involvement in epilepsy surgery pathways in the UK

Epilepsy surgery is an effective treatment for drug-refractory epilepsy. Epilepsy surgery multidisciplinary team involves a number of professionals, yet the role of neuropsychiatric care in surgical programs remains inconsistent. Despite the known psychiatric risks associated with epilepsy and its surgical interventions, there is no standardised approach to neuropsychiatric care in epilepsy surgery. This study evaluates the current level of neuropsychiatric involvement in epilepsy surgery centres across the UK, identifying current gaps and makes the consensus recommendation for optimal neuropsychiatric input.

A self-administered questionnaire was developed by the Royal College of Psychiatrists (RCPsych) Neuropsychiatry Faculty epilepsy surgery working group. It was distributed to all epilepsy surgical centres in the UK both in 2013 and 2021-22. The survey focused on service provision, available resources, operational aspects, and clinicians' perspectives on neuropsychiatric involvement in epilepsy surgery. Data from the two surveys were analysed to assess the prevalent practice and identify barriers to the provision of neuropsychiatric care.

A total of 12 responses were received in each survey out of a total of 15 centres. Findings indicate considerable variability in neuropsychiatric involvement, with inconsistent preoperative and postoperative assessments across centres. While most centres acknowledged the importance of neuropsychiatric input, resource constraints and a lack of formalised pathways result in fragmented service provision.

The findings emphasise the need for standardised neuropsychiatric care in epilepsy surgery programs. Routine pre-operative and post-operative assessments should be integrated into epilepsy surgery pathways. Establishing national guidelines and increasing funding for neuropsychiatric services are crucial steps toward ensuring consistent and equitable care for epilepsy surgery patients across the UK.