How neurologists' knowledge gaps may limit treatment options for epilepsy

Uncontrolled epilepsy is a major societal burden with significant impacts on patients' health and quality of life. This study evaluated neurologists' practices and perceptions in managing uncontrolled epilepsy in Spain. In this observational study, an anonymous, online, 23-item, qualitative survey was distributed to neurologists practising in Spain. Topics included demographics, perceptions of seizure control, knowledge of antiseizure medications (ASM) and clinical practices. Responses were analysed using descriptive statistics. A total of 127 participants (33 epilepsy specialists, 94 non-specialists) completed the survey; 114 of the 127 respondents (90%) had at least 5 years' experience in managing people with epilepsy. Among the 127 respondents, 76% (88% of specialists; 71% of non-specialists) defined controlled epilepsy as freedom from all seizures and 60% considered persistence of some seizures to be acceptable-at least to some extent. Ninety respondents (71%) reported having 16-30 min available for initial consultations with patients and 89 (70%) had 0-15 min available for follow-up consultations; 125 (98%) indicated that time constraints in consultations impact follow-up care. In terms of clinical experience/familiarity with ASM, epilepsy specialists were significantly more familiar with perampanel (p < 0.05), clobazam (p < 0.001), zonisamide (p < 0.05), cenobamate (p < 0.001), ethosuximide (p < 0.001), cannabidiol (p < 0.001), rufinamide (p < 0.001) and fenfluramine (p < 0.001) than non-specialists. The main challenges reported by the respondents when selecting a drug for uncontrolled epilepsy included 'adverse events' (57%), 'a preference for drugs in which they have more experience' (53%) and 'difficulty in keeping up to date with new medicines' (31%). There is a discrepancy between neurologists' treatment goals and their acceptance of persistent seizures in Spanish neurological practice. Several factors may be limiting the achievement of early seizure freedom, including short patient consultations and a lack of familiarity with new treatments, especially among epilepsy non-specialists. Addressing these barriers could improve outcomes for people with uncontrolled epilepsy.