title: Monitoring the changing pattern of delivery of paediatric epilepsy surgery in England--an audit of a regional service and examination of national trends.
abstract: OBJECTIVE
  The demand for paediatric epilepsy surgery in the UK greatly exceeds the number of operations performed. Hence, Children's Epilepsy Surgery Service (CESS) was commenced in 2012. This study is aimed to characterise the changes in service delivery in the North East of England Paediatric Neuroscience Network and nationally.
  
  
  METHODS
  A retrospective cohort study of paediatric epilepsy surgery in Leeds between 2005 and 2012 is presented followed by analysis of British Paediatric Neurosurgical Group (BPNG) data before and after CESS commissioning.
  
  
  RESULTS
  During the study period, 42 children underwent epilepsy surgery in Leeds. The commonest aetiologies were neoplasm (33%), focal cortical dysplasia (19%) and mesial temporal sclerosis (19%). Seizure outcome was 71 % EngelI and 83% EngelI+II. Complications included one infection (2%), two temporary (5%) and one permanent (2%) motor deficits, three new/worsened visual field deficits (7%). There were six re-craniotomies (14%). The BPNG data show a 48% increase in paediatric epilepsy surgery in England between 2009 (90 cases) and 2012 (133 cases), and a 20% fall in 2013 (106 cases)--the first calendar year for CESS. On average, 64% of all operations were performed in London.
  
  
  CONCLUSIONS
  The number of children receiving surgery for epilepsy in England had increased annually up to, and declined after, the establishment of CESS centres. The yearly caseload in neurosurgical units outside of London is small. The outcomes from Leeds are comparable to those published elsewhere. Other UK units are encouraged to publish outcomes to facilitate patient, commissioner and provider decision making.
authors.affiliation: Neurosurgery Department, Leeds General Infirmary, G Floor, Jubilee Wing, Leeds, LS1 3EX, UK.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Shastin
authors.forename: Suresh
authors.initials: S
authors.lastname: Chandrasekaran
authors.forename: Colin
authors.initials: C
authors.lastname: Ferrie
authors.forename: Gayatri
authors.initials: G
authors.lastname: Vadlamani
authors.forename: Matthew
authors.initials: M
authors.lastname: Morrall
authors.forename: Daniel
authors.initials: D
authors.lastname: Warren
authors.forename: Jeremy
authors.initials: J
authors.lastname: Macmullen-Price
authors.forename: Munni
authors.initials: M
authors.lastname: Ray
authors.forename: Vernon
authors.initials: V
authors.lastname: Long
authors.forename: John
authors.initials: J
authors.lastname: Goodden
authors.forename: Darach
authors.initials: D
authors.lastname: Crimmins
authors.forename: Gnanamurthy
authors.initials: G
authors.lastname: Sivakumar
authors.forename: Paul
authors.initials: P
authors.lastname: Chumas
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography; D004739:England / Q000453:epidemiology; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008330:Management Audit / Q000379:methods* / Q000639:trends*; D064926:Neurophysiological Monitoring / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D012016:Reference Values; D016896:Treatment Outcome