Referral Practices for Epilepsy Surgery in Pediatric Patients: A North American Study
Abstract number :
2.275
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1825632
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Sarah Grace Buttle, MD - Children's Hospital of Eastern Ontario; Katherine Muir, MD, FRCPC – Pediatric Neurologist, Children's Hospital of Eastern Ontario; Sajjad Dehnoei, MSc – Methodologist, Children's Hospital of Eastern Ontario Research Institute; Richard Webster, PhD – Methodologist, Children's Hospital of Eastern Ontario; Albert Tu, MD, FRCPC – Pediatric Neurosurgeon, Children's Hospital of Eastern Ontario
Rationale: Patients with epilepsy who do not respond to two trials of appropriate antiepileptic drugs are considered to have drug resistant epilepsy (DRE). The International League Against Epilepsy recommends patients with DRE be referred for surgical evaluation, however prior literature suggests this is an underutilized intervention especially in the pediatric setting. This study captures practices of North American pediatric neurologists regarding the management of DRE and factors which may promote or limit referrals for epilepsy surgical evaluation.
Methods: A REDCap survey distributed via the Child Neurology Society mailing list to pediatric neurologists practicing in North America. Ethics approval from the Children’s Hospital of Ontario Research Ethics Board (CHEO REB) was granted prior to the start of data collection. Statistical analyses including a binary logistic regression model were completed in R.
Results: 102 pediatric neurologists responded, 77% of whom currently practice in the United States. 73.5% of respondents reported they would refer a patient for surgical consultation after two failed medications. Of all potential predictors tested in a binary logistic regression model, low annual referral volume was the only predictor of whether participants refer patients after three or more failed medications (Table 1).
Conclusions: Pediatric neurologists demonstrate fair knowledge of formal recommendations to refer patients for surgical evaluation after two failed medication trials. Participants continue to report that they would not refer patients with generalized EEG findings for surgical evaluation; this should continue to be addressed. Other modifiable factors reported, especially family perceptions of epilepsy surgery, should be prioritized when developing tools to enhance effective referrals and increase utilization of epilepsy surgery in the management of pediatric DRE.
Funding: Please list any funding that was received in support of this abstract.: Children's Hospital of Eastern Ontario - Resident Research Grant.
Surgery