People with epilepsy often need surgery, but it is not fully known whether their stomachs empty food and liquids at the same rate as people without epilepsy. Some seizure medications, special diets, and nerve changes related to epilepsy may slow digestion, which could increase the risk of stomach contents entering the lungs during anesthesia. The purpose of this study is to find out whether people with epilepsy still have food or liquid in their stomachs before surgery, even after following standard fasting rules. To do this, researchers will use a simple bedside ultrasound scan of the stomach before surgery. The scan takes only a few minutes and does not involve needles, radiation, or pain and will determine what food and/or liquid may be present in the stomach before surgery. About 30 adults with epilepsy scheduled for surgery will take part in this study. The results of this study may help to inform whether or not the surgical fasting guidelines for epilepsy patients need to be modified. This is a prospective, observational study that will take place at University Hospital, London Health Sciences Centre.
Diagnosis of epilepsy (confirmed by history or medical records and classified as per 2025 ILAE classification for seizures).
Scheduled for elective neurologic (e.g., epilepsy surgery) or non-neurologic surgery under anesthesia.
18 years of age or older.
Adherence to standard fasting guidelines (verified by patient report).
Refusal/withdrawal of consent.
Noncompliance with fasting guidelines.
Pregnancy.
Patients with continuous treatment on GLP/GIP 1 analogues without a washout period.
Adult patients with epilepsy who are scheduled for surgery where general anesthesia will be used.
Cohort
Prospective
Gastric Ultrasound
Procedure/SurgeryPatients who provide consent to participate will have one gastric ultrasound performed in the preoperative preparation area. Each ultrasound will will be done in both the supine position and right lateral decubitus (RLD) position. Ultrasound gel will be applied to the patient's abdomen and the ultrasound probe will be placed on the abdomen midline just below the sternum using a curvilinear probe (usually 2-5 MHz). The following imaging and assessment will be performed: Gastric cross-sectional area: It will be assessed both in supine and Right Lateral Decubitus position as a full stomach (presence of solids or thick liquids) can be confirmed in the supine position but accuracy is significantly higher in RLD. Peristalsis: Frequency of contractions will be noted over a full 3-minute period.
Impact of epilepsy on gastric emptying after following pre-surgical fasting guidelines.
This will be measured by conducting preoperative point of care gastric ultrasounds on epilepsy patients, to determine the contents of their stomach, who arrived for surgery after following the surgical preparation fasting guidelines.
Impact of antiepileptic therapy on gastric emptying.
This will be measured by conducting preoperative point of care gastric ultrasounds on epilepsy patients, to determine the contents of their stomach, who arrived for surgery after following the surgical preparation fasting guidelines and corelating results with prescribed epileptic therapies of each participant.
Impact of epilepsy treatment on type of stomach contents present after following pre-surgical fasting guidelines.
This will be measured by conducting preoperative point of care gastric ultrasounds on epilepsy patients, to determine the contents of their stomach, who arrived for surgery after following the surgical preparation fasting guidelines and qualitatively assessing these contents as solids, liquids, or thick liquids.
Impact of epilepsy duration on gastric volume after following pre-surgical fasting guidelines.
This will be measured by conducting preoperative point of care gastric ultrasounds on epilepsy patients, to determine the contents of their stomach, who arrived for surgery after following the surgical preparation fasting guidelines and corelating results with the epilepsy duration of each participant.
Impact of seizure frequency on gastric volume after following pre-surgical fasting guidelines.
This will be measured by conducting preoperative point of care gastric ultrasounds on epilepsy patients, to determine the contents of their stomach, who arrived for surgery after following the surgical preparation fasting guidelines and corelating results with seizure frequency of each participant.
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