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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Barriers to epilepsy surgery in pediatric patients: A scoping review
Rami Hatoum1, Nabil Nathoo-Khedri1, Nathan A Shlobin2
1University of Montréal School of Medicine, 1845 Avenue Fontaine, Laval, Montréal, QC H7T 1N8, Canada.
Insights
Barriers to pediatric epilepsy surgery (ES) are complex, involving parents, physicians, patients, and healthcare systems. Addressing these multifaceted challenges is crucial to increase access to life-changing epilepsy surgery for children.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Healthcare Policy
Background:
- Up to 40% of pediatric epilepsy cases are drug-resistant, leading to significant comorbidities.
- Epilepsy surgery (ES) offers seizure freedom but is underutilized in eligible pediatric patients.
- Understanding barriers to ES is critical to improve treatment access.
Purpose of the Study:
- To identify and categorize barriers hindering the utilization of pediatric epilepsy surgery.
- To provide insights into the underutilization of ES in pediatric epilepsy management.
Main Methods:
- A comprehensive scoping review of Embase, PubMed, and Scopus databases was conducted.
- Studies were selected based on PICO terms: "pediatric", "parents", "epilepsy", "surgery", and "decision-making".
- Barriers were qualitatively synthesized and thematically categorized following PRISMA Sc-R guidelines.
Main Results:
- Seventeen studies identified four main categories of barriers to pediatric ES.
- Parental (76%), physician-based (65%), and patient-based (47%) barriers were most frequently reported.
- Healthcare system barriers (18%), such as insurance complexities, were less frequently described.
Conclusions:
- Pediatric epilepsy surgery faces multifaceted barriers across patient, caregiver, physician, and system levels.
- Multilevel strategies are essential to enhance the uptake of ES in pediatric epilepsy care.
- Addressing these barriers can improve seizure control and quality of life for children with drug-resistant epilepsy.
Rationale:
Up to 40% of pediatric epilepsy cases are drug-resistant and associated with neurocognitive, psychosocial, developmental comorbidities, and risk of early mortality. Epilepsy surgery (ES) may be considered after the failure of two anti-seizure medications (ASM) to provide patients with the opportunity to attain seizure freedom. However, only a small proportion of eligible patients receive surgical treatment. This scoping review aims to elucidate barriers to pediatric ES to understand the reasons for its underutilization.
Methods:
Embase, PubMed, and Scopus were searched from inception through August 2022 for the following PICO terms: "pediatric", "parents", "epilepsy", "surgery", and "decision-making". Studies exploring barriers to ES were included and qualitatively synthesized. We adopted an inductive thematical approach, and barriers hindering ES were assigned to four thematic categories. PRISMA Sc-R guidelines were followed.
Results:
Of 3400 retrieved studies, 17 were included. Barriers to ES were classified into 4 categories. Parental barriers originating from misperception, lack of knowledge regarding surgical outcomes, and emotional vulnerability were highlighted in 76% of included studies. Physician-based barriers, including lack of clinical expertise, trust, and communication, leading to inadequate informed consent and referral to surgical evaluation, were described in 65% of articles. Patient-based barriers were reported in 47% of studies and included clinical characteristics modulating acceptance of ES. Only 18% of studies described healthcare system-based barriers, including intricate insurance policies not adapted to sociodemographic disparities.
Conclusion:
This study highlights the complexity of barriers to pediatric ES. Our findings emphasize the need for multileveled strategies to increase the utilization of ES among eligible pediatric patients.
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