Abstracts

Rationale: Epilepsy affects nearly 1% of the world's population. Around 30 percent of epilepsy patients do not have remission of their seizures despite appropriate medical therapy. These patients should be considered for referral to an epilepsy surgery center for surgical evaluation. However, epilepsy surgery remains grossly underutilized and still seen as a last resort for patients with intractable epilepsy.Our aim was to better understand the barriers to epilepsy surgery utilization from the physician's perspective by surveying neurologists nationwide. The goal is use this information to develop targeted program to improve the utilization rates.  Methods: This was a prospective blinded survey designed and developed by researchers the George Washington University Epilepsy Center. The survey was IRB approved (09Jan2018) and was created in RedCap for distribution. A link to the survey was sent to a mailing list of 6250 neurologists in the United States utilizing the email blast service constant contact. The survey remained active for a year and a reminder was sent 5 times throughout the course of that year. Participants had the chance to only complete the survey once.  Results: The survey was sent to 6250 neurologists across the US, 275 individuals responded. About ½ of the respondents were from the Northeast region (47%). There were 135 non-epileptologists, 116 epileptologists and 23 did not provide an answer. Among the non epileptologist , (37%) felt that frequency of seizures was the most important driver to referring patients for epilepsy surgery, 71 % felt that all refractory epilepsy patients should be recommended for surgery. 48.8% think the most important concern from a patient perspective when surgery is discussed is the fear of surgery related complications. 60% of the non epileptologists had some degree of concern for surgery related complications, however 30% of them were open to the idea of referring their patients to an epilepsy center. 56% were comfortable with their knowledge regarding the option of epilepsy surgery which is consistent with the findings on questions regarding reasons to refer. However, almost half of the respondents (48.8%) reported that having access to a comprehensive epilepsy center affects their referral. Similarly 48% of epileptologists reported that patients have concerns with surgery related complications but had no concerns with recommending epilepsy surgery.  Access was also a significant with 48% of epileptologists stating that it affects their referral of patients for epilepsy surgery.  Conclusions: Epileptologists and non epileptologists have the knowledge regarding epilepsy surgery and when to refer patients for it. The most striking finding was the concern among the providers regarding access to a comprehensive epilepsy center. Our findings indicate that their needs to be a greater focus on improving access to a higher level of care for both the providers and the patients alike. The results from this survey will help in the development of future projects to address this need.  Funding: No funding