(Abst. 1.343 ), 2012
KNOWLEDGE OF PHYSICIANS AND PRACTICE PARAMETERS PERTAINING TO THE DIAGNOSIS AND DRUG MANAGEMENT OF PEDIATRIC EPILEPSY
Authors: C. A. Hovinga, K. L. Kime, N. R. Bower, J. B. Titus, F. F. Perkins, D. F. Clarke Instit: Dell Children’s Medical Center, University of Texas
Few studies have examined pediatric practitioner understanding of best practices in epilepsy. This study assessed the initial diagnosis and treatment practices of physicians seeing pediatric patients with epilepsy and concordance with current guidelines.
A survey was constructed to assess physician familiarity with guidelines pertaining to the evaluation and drug treatment of children with epilepsy. Information including physician age, number of years of practicing medicine, subspecialty, practice affiliation, and patient population was collected in order to see if there were any associations with guidelines. The survey was to health care providers in Central Texas whose focus is in pediatrics, family medicine, neurology, and neurosurgery.
146 (10%) responded to the survey. Among the total respondents 57.5% were from pediatrics, 12.6% from neurology/neurosurgery, and 29.9% were from family medicine. Approximately half the respondents were from private practice. Respondents saw a median of one (range: 0-100) new case of seizures per month and a median of 2.5 (range: 0-200) pediatric patients with epilepsy per month. Approximately half of the surveyed clinicians had been practicing medicine for less than 15 years. Overall, 6.3% felt that a child with a first febrile seizure needed an EEG, whereas 85% felt that an EEG should be obtained after the 1st unprovoked seizure. Half of respondents felt that an EEG should be ordered after the child has failed an AED. Family medicine practitioners were more likely to obtain an EEG after an initial seizure than pediatricians or those from neurology/neurosurgery. Eighty-three percent of physicians agreed that a CT or MRI should be ordered if a child has had 2 or more unprovoked seizures. Ninety-four percent agreed that one should be ordered if the child's physical or neurological examination suggested focal impairment. Eighty-eight percent felt a CT or MRI should be ordered if the child is being considered for epilepsy surgery and 71% felt one necessary if the child has any epileptiform abnormality on their EEG. Eighteen percent of physicians were unsure if an AED should be administered after the 1st unprovoked seizure. Fourteen percent were still unsure if one should be administered after more than 2 unprovoked seizures, and 12% were unsure if it should be after more than 3 unprovoked seizures. Twenty eight percent of physicians were unsure if failing 1 AED constituted as having intractable epilepsy. Likewise, about 1/3 of the respondents were unsure if children were considered as intractable if they had failed 2-3 AEDs. Thirty-five percent of physicians were still unsure if failing 6 or more AEDs meant a child had intractable epilepsy.
In general, physicians were in agreement with guidelines for obtaining EEGs and imaging in pediatric patients with epilepsy. However, there are significant misconceptions regarding AED management and understanding what constitutes drug resistant epilepsy.
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