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. 2022 Nov:102:83-95.
doi: 10.1016/j.seizure.2022.08.013. Epub 2022 Aug 31.

Barriers to epilepsy surgery in pediatric patients: A scoping review

Rami Hatoum  1 , Nabil Nathoo-Khedri  2 , Nathan A Shlobin  3 , Andrew Wang  4 , Alexander G Weil  5 , Aria Fallah  6
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Free article

Barriers to epilepsy surgery in pediatric patients: A scoping review

Rami Hatoum et al. Seizure. 2022 Nov.
Free article

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: Barriers; Decision-making; Epilepsy surgery; Parent; Pediatric.

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Conflict of interest statement

Declaration of Competing Interest All authors have no relevant financial relationships or conflicts of interest to disclose.

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