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Epilepsy surgery perceptions among general neurologists and epilepsy specialists: A survey.
Haneef, Zulfi; Patel, Kamakshi; Nguyen, Angela; Kayal, Gina; Martini, Sharyl R; Sullivan-Baca, Erin.
Afiliação
  • Haneef Z; Epilepsy Centers of Excellence, Veteran's Health Administration, USA; Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: haneef@bcm.edu
  • Patel K; Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
  • Nguyen A; University of Houston, 4800 Calhoun Road, Houston, TX 77204, USA.
  • Kayal G; Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
  • Martini SR; Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
  • Sullivan-Baca E; Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Neurology Care Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
Clin Neurol Neurosurg ; 237: 108151, 2024 02.
Article em En | MEDLINE | ID: mdl-38340429
ABSTRACT

OBJECTIVE:

Surgical intervention for drug-resistant epilepsy (DRE) is a safe and efficacious evidence-based treatment. Yet, neurologists have historically revealed hesitance in referring patients for surgical evaluations. The present study surveyed general neurologists and epilepsy specialists to assess their views and process in referring patients for specialized epilepsy care and epilepsy surgery.

METHODS:

A 14-item survey assessing epilepsy referrals and views of epilepsy surgery was distributed to all neurologists currently practicing in a large national integrated health system using REDCap. Responses were qualitatively analyzed and differences between general neurologists and epileptologists were assessed using chi-squared tests.

RESULTS:

In total, 100 responses were received from 67 general neurologists and 33 epileptologists with several similarities and differences emerging between the two groups. Both groups endorsed surgery and neuromodulation as treatment options in DRE, felt that seizure frequency rather than duration was relevant in considering epilepsy surgery, and indicated patient preference as the largest barrier limiting epilepsy surgery. General neurologists were more likely to require ≥ 3 ASMs to fail to diagnose DRE compared to epileptologists (45% vs. 15%, p < 0.01) who more often required ≥ 2 ASMs to fail. Epileptologists were also more likely than neurologists to try a new ASM (75.8% vs. 53.7%, p < 0.05) or optimize the current ASM (75.8% vs. 49.3%, p < 0.05) in DRE. General neurologists were more likely to consider epilepsy surgery to be less efficacious (p = 0.001) or less safe (p < 0.05).

SIGNIFICANCE:

Overall, neurologists appear to have generally positive opinions of epilepsy surgery, which is a change from prior literature and represents a changing landscape of views toward this intervention. Furthermore, epileptologists and general neurologists endorsed more similarities than differences in their opinions of surgery and steps to referral, which is another encouraging finding. Those gaps that remain between epileptologists and general neurologists, particularly in standards of ASM prescription, may be addressed by more consistent education about DRE and streamlining of surgical referral procedures.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Epilepsia / Epilepsia Resistente a Medicamentos Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Epilepsia / Epilepsia Resistente a Medicamentos Idioma: En Ano de publicação: 2024 Tipo de documento: Article