Barriers, attitudes, and perceptions regarding epilepsy surgery among patients in rural Thailand: A multicenter study

Strong evidence supports epilepsy surgery as a safe and effective treatment option for a subset of patients with drug-resistant epilepsy. However, multiple factors, including patient factors, contribute to the underutilization of this treatment. Hence, we conducted this multicenter study to explore the attitudes and barriers to epilepsy surgery in Thailand.

A 40-item self-administered questionnaire was administered to consecutive adults with drug-resistant epilepsy treated in neurology clinics at seven centers in Thailand. The questionnaire was divided into five sections: (1) general demographic data and epilepsy; (2) knowledge of epilepsy surgery; (3) perception of risks of surgery and ongoing seizures; (4) perception and belief regarding barriers in the health insurance system to epilepsy management, including epilepsy surgery; and (5) possible barriers affecting the decision to undergo surgery. A composite score of the responses to each of the 10 questions representing "barriers to epilepsy surgery" was calculated to assess the factors associated with attitudes toward surgery.

A total of 456 consecutive patients with drug-resistant epilepsy completed the questionnaire (response rate: 98.1%). Notably, 79% of participants with drug-resistant epilepsy were unaware of epilepsy surgery as a treatment option, with 60% tending to overinterpret surgical risks. Almost all patients (86%) either strongly or somewhat agreed with the statement, "brain surgery should be considered a last resort." Education level, current employment status, and net income were associated with barriers to epilepsy surgery.

The findings of this study may help to identify knowledge gaps to improve information strategies.