Many physicians misinformed about initial diagnosis and treatment of epilepsy

A survey of healthcare providers concerning the initial diagnosis and treatment of epilepsy has found significant misinformation held among physicians who see children who have seizures. Many physicians surveyed are misinformed about what constitutes intractable epilepsy, when to refer their pediatric patients for surgical evaluation, and what types of seizures may be amenable to surgical intervention.

A number of best practice guidelines for the care of epilepsy patients, including guidance in the care of pediatric patients who have seizures, have recently been developed and/or updated and promulgated by the leading national and international medical specialty organizations concerned with epilepsy. The survey of providers was carried out to assess concordance between current best practice guidelines and clinical practice for epilepsy in pediatrics. (Abstracts #1.342 & #1.343)

In addition to misinformation pertaining to surgery, knowledge concerning diagnosis and drug management in pediatric patients was also marked by important gaps. There was agreement in general about obtaining an EEG and CT or MRI brain image. But respondents were significantly less informed about when or after how many seizures anticonvulsant drug (AED) therapy should be initiated. Those surveyed were equally as misinformed about how many AED failures should be allowed before another therapeutic mode should be considered.

The survey of healthcare providers was conducted in Central Texas by researchers at the University of Texas Southwestern Medical Center, Dallas, and Dell Children's Medical Center, Austin, who believe the findings are not particularly unique to their region of the country. The results were presented today during the American Epilepsy Society 66th Annual Meeting at the San Diego Convention Center by Freedom F. Perkins, Jr., M.D., Staff Epileptologist at Dell Children's Medical Center Comprehensive Epilepsy Program.

"Observance of practice standards is important in achieving optimal seizure control and quality of life for epilepsy patients," said Dr. Perkins. "Early aggressive treatment is essential. But timely and appropriate care is not likely to happen if healthcare providers are misinformed. This survey gives us baseline information that can be used to focus educational initiatives for improving provider knowledge."

Survey respondents were almost equally divided by gender and half were in private practice. In terms of practice focus, 57.5% were from pediatrics, 29.9% from family medicine, and 12.6% from neurology/neurosurgery. The median number of new pediatric patients with epilepsy seen each month was 2.5 (range 0 - 200).