Survey explores why patients refuse epilepsy surgeries
A range of patient attitudes and anxieties stand in the way of surgical intervention for epilepsy becoming more widely accepted, according to a recent study.
In well-selected candidates whose epilepsy is refractory – meaning they do not respond to conventional, drug-based therapies – surgical resection is successful as a means of stopping seizures “approximately two-thirds of the time”, researchers from the Medical College of Wisconsin’s Department of Neurology claimed.
However, a sizable proportion of potential candidates refuse to undergo surgery – even after a presurgical work-up. “The reasons why patients decline potentially effective surgery are not completely understood,” they went on.
To establish the socio-cultural, medical, personal and psychological factors that might inform these patients’ decisions, the researchers prepared a novel questionnaire that was fielded to 23 people who agreed to undergo epilepsy surgery and nine who did not.
They found that the subjects who did not consent to surgical intervention tended to be “less bothered” by their epilepsy – regardless of the condition’s severity – and were more troubled by anxieties surrounding the surgery itself. They were also less likely to listen to the opinions of doctors and peers than their counterparts who accepted treatment, and were more likely to have comorbid psychiatric diseases.
Meanwhile, patients who chose surgery were typically more troubled by their epilepsy in day-to-day life – being embarrassed by their seizures, for example. They were more excited about the prospect of life without the symptoms of epilepsy and less anxious about specific aspects of surgical intervention.
The researchers concluded that a number of factors “serve as barriers to ideal care” and suggested their findings could be used in future to improve clinician education, while also serving as a basis for establishing whether or not specific treatment options should be offered to certain patients.
For instance, an individual who fits the profile of someone who is likely to refuse surgery could be withheld from presurgical testing, which can be risky and expensive to undertake.