Attitude and Barriers Towards Epilepsy Surgery: A Survey Among Pediatricians and Pediatric Residents in Türkiye

Abstract

Objective: The aim of this study was to assess knowledge and attitude towards epilepsy surgery among pediatricians and identify the barriers to referral for epilepsy surgery in Türkiye. Material and Methods: There were 21 statements which included the following: (A) knowledge (B) attitude and (C) barriers towards epilepsy surgery. The survey was mailed to 368 pediatricians. Results: Among responders (n=240); 56.6% (n=136) were pediatricians and 44.4% (n=104) were pediatric residents. Three quarters (76 %) of them had experiences in neurology department and 60.1 % of them encountered ≥30 epilepsy patients per month. Most of participants who had no idea whether epilepsy surgery is one of the treatment options were residents (p=0.046). Almost all responders (97.5%) agreed to consult a DRE (Drug Resistant Epilepsy) patient to a pediatric neurologist for medical options. Nearly half of them (43.2%) had no idea about long-term positive cognitive effects. Whereas one-third of participants stated that it is not a safe process; more than half (57%) reported not knowing where and when to refer these patients. Conclusion: An important finding was the apparent lack of inadequate knowledge of long-term benefits and the specificity of epilepsy surgery although most of them had previous experience in neurology department. Besides the lack of epilepsy surgery centers, lack of communication is also a problem in planning the referral of patients.

Keywords

• Drug Resistant Epilepsy
• Pediatrics
• Survey

References

1. Dabrowski A, Armstrong C. A pediatrician’s guide to epilepsy surgery. Curr Probl Pediatr Adolesc Health Care 2024;54:101578.
2. Dwivedi R, Ramanujam B, Chandra PS, Sapra S, Gulati S, Kalaivani M, et al. Surgery for Drug-Resistant Epilepsy in Children. N Engl J Med 2017;377:1639-47.
3. Nordli Iii DR, Taha M, Freund B, Nordli DR Jr, Galan F. Minimally Invasive Epilepsy Surgery. Neuropediatrics 2024;55:279-88.
4. Ramantani G, Wirrell E. Epilepsy surgery in developmental and epileptic encephalopathies. Epilepsy Behav 2024; 59:109985.
5. Jeno M, Zimmerman MB, Shandley S, Wong-Kisiel L, Singh RK, McNamara N, et al. Pediatric Palliative Epilepsy Surgery: A Report From the Pediatric Epilepsy Research Consortium (PERC) Surgery Database. Pediatr Neurol 2024;157:70-8.
6. Zupan G, Lorber B. Knowledge and Awareness of Epilepsy Surgery among Medical Students. J Epilepsy Res 2017;7:50-3.
7. Roberts JI, Hrazdil C, Wiebe S, Sauro K, Vautour M, Wiebe N, et al. Neurologists’ knowledge of and attitudes toward epilepsy surgery: a national survey. Neurology 2015;84:159-66.
8. Berg AT, Loddenkemper T, Baca CB. Diagnostic delays in children with early onset epilepsy: impact, reasons, and opportunities to improve care. Epilepsia 2014;55:123-32.

9. Aljafen B, Alomar M, Abohamra N, Alanazy M, Al-Hussain F, Alhumayyd Z, et al. Knowledge of and attitudes toward epilepsy surgery among neurologists in Saudi Arabia. Neurosciences (Riyadh) 2020;25:43-9.
10. Hale AT, Chari A, Scott RC, Helen Cross J, Rozzelle CJ, Blount JP, et al. Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing? Brain 2022;145:3755-62.
11. Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol 2014;13:1114-26.
12. Skirrow C, Cross JH, Cormack F, Harkness W, Vargha-Khadem F, Baldeweg T. Long-term intellectual outcome after temporal lobe surgery in childhood. Neurology 2011;76:1330-7.
13. Prideaux L, Barton S, Maixner W, Harvey AS. Potential delays in referral and assessment for epilepsy surgery in children with drug-resistant, early-onset epilepsy. Epilepsy Res 2018; 143:20-6.
14. Cothros N, Burneo JG, Steven DA. Knowledge and Attitudes About Epilepsy Surgery Among Family Doctors in Ontario. Can J Neurol Sci 2016;43:672-7.
15. Harvey AS, Cross JH, Shinnar S, Mathern GW. ILAE Pediatric Epilepsy Surgery Survey Taskforce. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia 2008;49:46-55.
16. Pindrik J, Hoang N, Smith L, Halverson M, Wojnaroski M, McNally K, et al. Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy. Neurosurg Focus 2018;45: E3.
17. de Flon P, Kumlien E, Reuterwall C, Mattsson P. Empirical evidence of underutilization of referrals for epilepsy surgery evaluation. Eur J Neurol 2010;17:619-25.
18. Haneef Z, Stern J, Dewar S, Engel J Jr. Referral pattern for epilepsy surgery after evidence-based recommendations: a retrospective study. Neurology 2010;75:699-704.
19. Hatoum R, Nathoo-Khedri N, Shlobin NA, Wang A, Weil AG, Fallah A. Barriers to epilepsy surgery in pediatric patients: A scoping review. Seizure 2022;102:83-95.
20. Drees C, Sillau S, Brown MG, Abosch A. Preoperative evaluation for epilepsy surgery: Process improvement. Neurol Clin Pract 2017;7:205-213.