Commentary
Video
Improving Access to Surgical Evaluation in Drug-Resistant Epilepsy: Satyanarayana Gedela, MD
WATCH TIME: 5 minutes
"Once you reach intractable epilepsy, the chances of becoming seizure-free drop to less than 5% after trying the third, fourth, fifth, or more medications. You need more than just medications at that point to have a chance at being seizure-free, and that’s when we consider epilepsy surgery."
Recent research has shown that pediatric epilepsy surgery is performed in a small proportion of eligible pediatric patients with drug-resistant epilepsy (DRE), with estimates ranging from 1% to 11%. Published in Seminars in Pediatric Neurology, a systematic review of studies indexed in PubMed, EMBASE, and Web of Science examined factors associated with this low utilization. In the review, researchers identified potential influences such as family perceptions of surgery, provider familiarity with treatment pathways, and healthcare system-level disparities.1
Conducted by coauthor Satyanarayana Gedela, MD, chief of neurology at Nemours Children’s Hospital, Florida, the review also explored outcomes and resource considerations, noting that although epilepsy surgery involves a significant initial cost, some studies reported long-term reductions in healthcare use and improved clinical outcomes, including seizure control and cognitive function. Authors noted that these findings suggest that additional efforts across patient, provider, and system levels may help address barriers to access to epilepsy surgery for pediatric patients.
In a recent conversation with NeurologyLive®, Gedela, who also serves as a professor of pediatrics at the University of Central Florida School of Medicine, discussed the evolving landscape of epilepsy diagnosis and treatment. He explained the definition and clinical course of drug-resistant epilepsy and underscored the critical need for early referral to specialized epilepsy centers. By outlining the stepwise approach to presurgical evaluation, he advocated for increased awareness and access to comprehensive care to reduce seizure burden in patients who are not responsive to medications.
