Identifying drug-resistant epilepsy patients in primary care

Drug-resistant epilepsy remains a critical challenge in pediatric care, with far-reaching implications for patient outcomes. “If a patient fails two medications, the likelihood that the next medication will result in seizure freedom is less than 5%,” stated H. Westley Phillips, MD, pediatric neurosurgeon-scientist and epilepsy researcher at Stanford Medicine Children’s Health, in this Contemporary Pediatrics interview. As Epilepsy Awareness Month brings this issue to the forefront, Phillips explained how primary care providers can help identify these patients for early referral and advanced interventions.

“We have very recent data demonstrating that the time from diagnosis of epilepsy to surgical evaluation can be upwards of 16 years,” Phillips emphasized. This delay often prevents patients from accessing effective options like epilepsy surgery.

To facilitate early detection, Phillips encouraged pediatricians to maintain a high index of suspicion during routine visits. He explained, “A quick referral to the pediatric neurologist if there are concerns about seizures can help diagnose a seizure that may not look like a stereotypical, generalized tonic-clonic seizure, but something more focal.”

Once a diagnosis of epilepsy is established, pediatricians play an ongoing role in monitoring treatment efficacy. “If a patient has trialed multiple medications and are still having seizures, it is worthwhile to bring up to that patient and patient's family if there has been a discussion about epilepsy surgery,” Phillips said. He noted a disconnect in the understanding of surgical evaluations and their efficacy for drug-resistant epilepsy.

“For cases of surgical resection or ablation, we’re talking about seizure freedom rates in the 60% to 70%, and with neuromodulation, which has greatly expanded the number of patients eligible for surgery, we’re talking about a conservative estimation of about 50% reduction in 50% of patients,” Phillips explained.

By fostering collaboration between pediatricians, neurologists, and epilepsy specialists, Phillips believes medicine can rise to meet this challenge.

“All of medicine I consider a team sport. I think epilepsy, maybe more so, or just as much as any other aspect of medicine, really relies on the team," said Phillips.