Abstracts

Rationale: Thirty percent of epilepsy patients do not respond to medical treatment. The ILAE define Drug-resistant epilepsy as a failure of adequate trials of two tolerated and appropriately chosen and used AED schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. In the appropriate setting epilepsy surgery has been associated with high rates of seizure freedom. The National Association of Epilepsy Centers recommends that patients should be referred to a specialized epilepsy center within one year if seizures are refractory. Boston Children's Hospital has 74 neurologists who manage more than 5000 unique patients with epilepsy. Within the department there is a specialized epilepsy center that acts as a local, national and international referral center for patients with drug resistant epilepsy. Methods: A survey was developed to evaluate neurologist's current knowledge and practices regarding drug resistant epilepsy and epilepsy surgery A 19- item questionnaire was then developed that covered: demographics, definition of drug resistant epilepsy, factors considered in referral of patients for epilepsy surgery, and opinion of epilepsy surgery. The survey was emailed to all neurologists, neurology residents, and neurology fellows at Boston Children's Hospital. All surveys were anonymous. Results: Seventy four survey were sent. Twenty seven surveys were returned (36%). Sixty three per cent of responses were from attendings. Twenty two percent were from residents and the remainder were from fellows. Almost half of respondents (48%) had been in practise for 5 - 9 years. Thirty seven percent had been in practise for less than 5 years. Fifty two percent of respondents accurately defined medically refractory epilepsy. Fifty percent of respondents consider the duration of epilepsy before referring a patient for evaluation for epilepsy surgery. Eighty five percent consider the seizure type before referring a patient for evaluation for epilepsy surgery. Eighty nine percent consider the seizure frequency. Forty four percent consider the patient's developmental status. Eighty five percent of respondents would refer a patient with a normal MRI for epilepsy surgery. Forty four percent of respondents thought epilepsy surgery is under recommended. Conclusions: Approximately half of the neurologists who responded appropriately defined medically refractory epilepsy. Seizure frequency and seizure type are the important determinants for referral for epilepsy surgery. Further internal education is needed to facilitate optimum timing of referral for evaluation for epilepsy surgery for neurologists in a hospital where a comprehensive epilepsy center is based. Education should focus on the definition of medically refractory epilepsy, the characteristics of patients appropriate for referral and the need not to consider the patient's developmental status.