Surgery in intractable epilepsy-physicians' recommendations and patients' decisions

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Intractable focal epilepsy requires presurgical evaluation, including video-EEG monitoring (VEM) and potentially resective surgery.
• Patient decisions against physician recommendations impact treatment pathways.

Purpose of the Study:

• To identify factors influencing patient decisions to refuse resective epilepsy surgery or further invasive VEM.
• To analyze demographic and clinical variables associated with treatment refusal.

Main Methods:

• Retrospective analysis of consecutive patients undergoing presurgical VEM between 2010-2014.
• Multivariate analysis to determine independent variables associated with patient refusal of recommended procedures.

Main Results:

• Nearly 20% of eligible patients declined resective surgery after VEM.
• Approximately 50% of patients recommended for invasive VEM declined the procedure.
• Intellectual disability, presence of aura, and MRI lesions were independently associated with refusal of invasive VEM.

Conclusions:

• A significant proportion of patients with intractable focal epilepsy refuse recommended surgical or invasive monitoring procedures.
• Early and comprehensive patient counseling on epilepsy surgery risks and benefits is crucial.
• Further research should explore patient-specific reasons for declining medical recommendations.