Acceptance of epilepsy surgery among adults with epilepsy — What do patients think?

Physician inertia is usually blamed for the underutilization of epilepsy surgery (ES) at the cost of increased patient disability and risk of mortality. Investigations on selected groups of patients with intractable TLE and minorities suggested that patient beliefs may also limit access to ES. To assess acceptance of ES among “mainstream” patients, we distributed an ad hoc questionnaire to 228 adults attending epilepsy clinics and found widespread fears and misconceptions leading to unfavorable perception of ES, irrespective of diagnosis, seizure type, and degree of intractability. Moreover, while a group firmly rejected ES, the majority became more favorable when given further information about modality, rationale, and expected outcome of ES. Attitude changes correlated with patient's social profile. Neurologists are responsible for providing all pertinent information to potential surgical candidates as soon as indicated. Therefore, an untimely or inadequate intervention of the treating physician constitutes an additional barrier to optimal utilization of ES.

► The study assessed how prevalent the reluctance is to undergo epilepsy surgery.
► Reluctance to undergo surgery is mainly due to overestimation of the risks.
► Patient “barriers” can limit access to a potentially curative intervention.
► The amount of information patients receive has a key role in increasing acceptance.