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Barriers to epilepsy surgery in pediatric patients: A scoping review

      Highlights

      • Epilepsy surgery is effective and safe in selected children, yet underutilized.
      • Barriers to surgery relate to parents, patients, physicians, and healthcare system.
      • Parental misperception of epilepsy surgery was the most common barrier to treatment.
      • Physicians play a pivotal role in guiding parents through decision-making.

      Abstract

      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.

      Keywords

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