The unfamiliarity of some neurologists with recommended practice standards, coupled with access barriers, may be preventing eligible patients with epilepsy from undergoing surgical treatment, survey findings suggest.
In an editorial accompanying the study in Neurology, Lara Jehi (Cleveland Clinic, Ohio, USA) and Gary Mathern (University of California, Los Angeles, USA) say: “The current reality is that on average, adult patients who do get surgery have had intractable epilepsy for 20 years or more, and many who come for evaluation never knew they might be surgical candidates.”
The current study, by Nathalie Jetté (University of Calgary, Alberta, Canada) and team, assessed the answers of 425 (53.5%) of 796 Canadian neurologists who responded to their questionnaire, of whom 327 treated patients with epilepsy.
Although almost 90% of the respondents believed themselves to be familiar with indications for epilepsy surgery, their responses to specific questions showed otherwise. For example, 56.6% of respondents thought a minimum seizure frequency was necessary to prompt referral for surgery, and 48.6% were not aware of the definition of resistance to treatment (resistance to two antiepileptic drugs).
Also, 45.9% thought there was a minimum period of drug-resistance to be observed before referral, and the same proportion thought that patients with generalised epilepsies were not candidates for surgery.
There were also practical barriers to epilepsy surgery. Although 86.5% of respondents said they had access to the necessary resources to allow surgery in appropriate patients, most identified practical problems, with long wait times for surgery the most prominent, cited by 34.4%. Other problems reported included limited resources, access and distance.
“This feasibility gap remains a particularly vexing and an especially underrecognized challenge”, observe Jehi and Mathern in their editorial.
They also say that the survey respondents differed significantly in several respects from the neurologists who did not respond. Notably, those who did not respond were older, being significantly more likely to have graduated from medical school before 1985, making them “presumably less exposed to recent guidelines and less facile with modern tools of knowledge dissemination”, say the editorialists.
“As such, the nonresponders may be exactly the group that we need to understand better if we are to make a difference. This understanding requires a direct dialog rather than assuming opinions about their lack of engagement and their barriers from their silence, as is usually done in surveys, including this one.”
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By Eleanor McDermid, Senior medwireNews Reporter