Abstracts

Rationale: Practice guidelines stipulate that epilepsy surgery should be considered in patients with drug resistant focal epilepsy, yet referral patterns have not changed and epilepsy surgery continues to be underutilized. Patients still wait on average 10-20 years before surgical referral. One recent study shows that non referral by neurologists is even higher than that by family physicians. We aimed to determine neurologists' knowledge and attitudes towards epilepsy surgery in addition to their perception of local barriers to appropriate and timely surgical evaluation. Methods: A 5-minute nationwide paper or electronic questionnaire was administered to all Canadian neurologists registered with the Canadian Medical Directory. Content validity was completed through literature review and serial face-to-face revisions achieving agreement about each questionnaire component. Face validity was achieved by administering it to ten neurologists from across Canada. Descriptive statistics were calculated. Results: Of 825 listed Canadian adult and pediatric neurologists who were contacted, 332 responded after the second reminder (response rate 40%). Of the respondents, 294 saw epilepsy patients and were asked to complete the questionnaire in full. Over half (58%) practiced general neurology, while 11% specialized in epilepsy/EEG. Most were affiliated with an academic institution (78%) and had access to an epilepsy program in their city (77%). Respondents were generally well informed about epilepsy surgery. Just under 90% reported feeling quite knowledgeable about the indications for epilepsy surgery. Almost all (96%) felt that epilepsy surgery is safe when performed in carefully selected patients. The risk of clinically significant (disabling) and permanent adverse effects from anterior temporal lobectomy was appropriately estimated at under 10% in 96% of respondents. While 87% of those surveyed felt that they had access to adequate expertise, technology and resources to allow for appropriate selection of epilepsy surgical candidates, the majority reported concerns about temporal and physical barriers to access; 20% estimated their waitlists for surgical evaluation at over 1 year, and there was a frequent need to refer patients to better-equipped centers in other jurisdictions. Geographic variations in responses were explored. Areas for improvement included poor familiarity with epilepsy surgery clinical practice guidelines (56%) and the recent definition of drug-resistant epilepsy (66%); 43% believed that at least 3 antiepileptic drugs must fail in order for a patient to be drug-resistant. Conclusions: While most Canadian neurologists are well-educated about epilepsy surgery, there remains a need for better knowledge dissemination tools amongst neurologists. Resource limitations are identified as the largest nationwide barrier to optimization of surgical availability for those with refractory epilepsy. The association between neurologists' responses and actual practice requires exploration.