Epilepsy surgery: factors that affect patient decision-making in choosing or deferring a procedure

Area of Science:

• Neurosurgery
• Epileptology
• Patient Psychology

Background:

• Refractory epilepsy surgery offers seizure freedom in approximately two-thirds of well-selected patients.
• Many suitable candidates decline surgical intervention after presurgical evaluation.
• Reasons for declining surgery are not fully understood.

Purpose of the Study:

• To explore socio-cultural, medical, personal, and psychological factors influencing patient decisions regarding epilepsy surgery.
• To identify differences between patients who chose surgery and those who declined it.

Main Methods:

• A novel questionnaire was developed to assess factors in patient decision-making.
• Comparison of patient profiles who chose (n=23) versus declined (n=9) surgical intervention.

Main Results:

• Patients declining surgery reported being less bothered by epilepsy, higher surgical anxiety, less adherence to medical advice, and more comorbid psychiatric conditions.
• Patients choosing surgery expressed greater embarrassment from seizures, a stronger desire for seizure freedom, and lower specific surgical anxieties.
• Patient attitudes, beliefs, and anxiety levels act as significant barriers to optimal epilepsy treatment.

Conclusions:

• Understanding patient decision-making can inform targeted educational and interventional strategies.
• Identifying patients likely to decline surgery may prevent unnecessary and costly presurgical testing.