Awareness for epilepsy surgery among drug-resistant pediatric patients

H. Westley Phillips, MD, pediatric neurosurgeon-scientist at Stanford Medicine Children’s Health, discussed advancements in surgical options and neuromodulatory technologies for treating pediatric drug-resistant epilepsy, in the Contemporary Pediatrics video interview. He emphasized the importance of early referrals and the hope these innovations bring to patients and families.

Drug-resistant epilepsy can have major neuropsychological consequences on the developing brain, and that after failing two or more medications, the haste in which patients are evaluated for surgery really can dictate outcomes,” stated Phillips.

"The data has shown that epilepsy surgery is both safe and effective in treating drug-resistant epilepsy, and so the number of patients that come in, undergo a surgical evaluation, and successful surgery—the most common thing I hear is, ‘We wish we would have done this sooner.’”

Pediatricians are critical in facilitating early referrals for patients who may benefit from surgical interventions, says Phillips. For families at the initial stages of treatment, Phillips highlighted the importance of reassurance.

“What I always tell patients is that we have developed more efficient ways to localize seizure foci and new techniques that have allowed for the treatment of epilepsy by targeting regions of the brain. We have expanded the numbers of patients that are eligible and would potentially benefit from surgery through technology such as neuromodulation," said Phillips.

Advancements in neuromodulatory devices have significantly broadened treatment possibilities. “Patients that may have been deemed inoperable or not good surgical candidates even as soon as 5 or 10 years ago, there are now options with really great outcomes,” Phillips explained. These include devices such as responsive neurostimulation and deep brain stimulation.

Phillips also stressed the continuous evolution of surgical tools for patients with even the most refractory epilepsy cases.

“Because our surgical armamentarium is expanding, for patients with drug- and surgically-resistant epilepsy—meaning they’ve failed medications and also have had a surgery, sometimes that’s a vagus nerve stimulator or other surgeries—with today’s technology, we are able to offer and provide other interventions that can increase or improve seizure control," he said.

Phillips concluded with a message of optimism, having said, “It’s very rare for me to tell a patient, ‘Well, there’s nothing else we can do.’ The thing that I emphasize to patients and their families is that there's hope and that there are new therapies."