Unlocking seizure freedom: A European Delphi panel study on the clinical, humanistic, and economic value of seizure control in epilepsy.

BACKGROUND

Seizure freedom (SF) is widely recognized as a key goal in epilepsy treatment, yet its value is inconsistently defined, applied, and communicated in both clinical and research contexts. This lack of consensus limits the alignment of clinical care, trial design, and patient-centered outcomes.

OBJECTIVE

To generate expert consensus on the definition, relevance, and value of SF in epilepsy, and to inform its future integration into treatment guidelines, health policy, and economic evaluations.

METHODS

A three-round Delphi panel was conducted involving 28 stakeholders, including epileptologists, neurologists, patient advocacy representatives, nurses, and Health Economics and Outcomes Research (HEOR) experts from EU countries and the UK. Participants responded to structured questionnaires covering clinical, social, and economic aspects of seizure freedom. Consensus thresholds were pre-defined based on question type.

RESULTS

High consensus was reached on the definition of SF as "no seizures for 1 year or more" and its importance as a primary endpoint in studies involving newly diagnosed patients and surgical interventions. In studies and clinical practice involving drug-resistant patients, consensus was also reached, on SF not being the sole primary endpoint. Patient-centered priorities, including improved quality of life, psychological well-being, and functional independence, were identified as key benefits of SF. Economic and societal impacts of uncontrolled seizures were also rated as highly significant and impactful.

CONCLUSION

The Delphi panel findings highlight SF as a clinically meaningful, patient-prioritized, and economically valuable outcome. These insights should guide the standardization of SF definitions, support its broader use in health technology assessment (HTA), and inform shared decision-making in clinical practice in resource-rich environments in Europe.