Objective: Novel and minimally invasive neurotechnologies offer the potential to reduce the burden of epilepsy while avoiding the risks of conventional resective surgery. Few neurotechnologies have been tested in randomized controlled trials with pediatric populations, leaving clinicians to face decisions about whether to recommend these treatments with insufficient evidence about relevant risks and benefits. This study specifically explores the preferences of clinicians to treat pediatric drug resistant epilepsy (DRE) with novel neurotechnologies.
Methods: A discrete-choice experiment (DCE) was designed to elicit preferences of clinicians with experience in treating children with DRE using novel neurotechnological interventions. Preferences for six key attributes used when making treatment decisions (chances of clinically significant improvement in seizures, major and minor risks from intervention, availability of evidence, financial burden for the family, and access to the intervention) were estimated using a conditional logit model. The estimates from this model were then used to predict adoption of existing novel neurotechnological interventions.
Results: Sixty-eight clinicians completed the survey: 33 neurosurgeons, 28 neurologists, and 7 other clinicians. Most clinicians were working in the USA (74%), and the remainder (26%) in Canada. All attributes, apart from the nearest location with access to the intervention, significantly influenced preferences. The chance of clinically significant improvement in seizures was the most positive influence on clinician preferences, but low-quality evidence and a higher risk of major complications could offset these preferences. Of the existing neurotechnological interventions, vagus nerve stimulation was predicted to have the highest likelihood of adoption; deep brain stimulation had the lowest likelihood of adoption.
Significance: Clinician preferences are primarily driven by the likelihood of achieving seizure freedom for their patient, but preferences for an intervention are largely eradicated if only low quality of evidence supporting the intervention is available. Until better evidence supporting the use of potentially effective, novel neurotechnologies becomes available, clinicians are likely to prefer more established treatments.