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.

Copyright and license

Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Dedeoğlu Ö, Yılmaz D, Ardıçlı D, Gürkaş E, Kurt AN, Kartal A. Attitude and Barriers Towards Epilepsy Surgery: A Survey Among Pediatricians and Pediatric Residents in Türkiye. Turk J Pediatr Dis [Internet]. 2025 May 14 [cited 2025 Jul. 6];19(3):118-22. Available from: https://turkjpediatrdis.org/article/view/1088