Clinical reasoning and investigations for resective surgery for medically refractory epilepsies in children

The article presents results of a UK survey of pediatric neurologists' views regarding resective surgery for medically refractory epilepsies in children. In contrast to surveys with adult neurologists, the findings indicate that delays to surgery in the pediatric field are not likely to be due to clinicians' views. There is, however, variability in clinicians' opinions as to what constitutes medically refractory epilepsy, variability in the factors reported as necessary for surgery eligibility, and uncertainty as to how these concepts should be defined. The survey highlights the need for elucidation of the epilepsy surgery process for pediatric patients, clear communication between epilepsy surgery centers and referring neurologists, and dissemination of consensus guidelines relating to the criteria for both medically refractory epilepsy and surgery eligibility.

► Delays to surgery are not likely to be due to clinicians' views.
► Clinicians' opinions vary as to what constitutes medically refractory epilepsy.
► There is variability in the factors reported as necessary for surgery eligibility.
► There is a need for clear communication between surgery centers and neurologists.
► Medically refractory epilepsy/surgery eligibility guidelines: dissemination needed.