Abstracts

Physicians are usually blamed on the underutilization of epilepsy surgery. Other potential causes that could explain the low number of referrals to surgery appear to have received little attention, or to be considered less important. In a study done at seven surgical centers in the USA, only 14,3% of the eligible patients withdrew from the presurgical evaluation that had been offered to them (Epilepsia 2003; 44:1425-33). Data from hospitals lacking epilepsy surgery facilities seem to be very scarce, although this information could be very relevant. We reviewed the records of all our patients who were proposed to undergo an evaluation for epilepsy surgery at another center. We assessed the degree of rejection to this treatment option, as well as the causes related to it. The study was done at the Neurology Department of the Hospital Xeral, a general hospital with a catchment population of 250,000 people located in Vigo (NW Spain). Only patients aged 15 or more years have access to our Department. A total of 39 patients were collected. In three cases the request for surgery came from the patients themselves and, therefore, they were excluded from this analysis. The mean age of the remaining 36 patients, at the time of the proposal, was 36,8 years (range: 15-60). There were 14 men and 22 women. Their diagnoses were: temporal lobe epilepsy in 25 (associated with hyppocampal atrophy in 13, cryptogenic or idiopathic in 8, due to benign tumors in 3, and secondary to a cavernoma in 1), non-lesional extratemporal epilepsy in 6, cortical dysplasia in 2, and cryptogenic Lennox-Gastaut syndrome with frequent drop-attacks, Rasmussen encefalitis, and parietal lobe cavernoma (1 each). Only nine (25%) out of these 36 patients accepted the proposal when first done, while another seven patients (19,4%) accepted only after repeated offers. The remaining 20 patients (55,5%) have rejected the possibility of surgical treatment, in spite of new explanations and proposals (up to seven). Most of them expressed a great concern about the potential negative consequences of brain surgery. In our setting, the main reason for the underuse of epilepsy surgery was the high degree of rejection (more than 50%) showed by our patients to this type of treatment. It would be interesting to know if this attitude is also common in other general hospitals without epilepsy surgery programs. In this case, campaigns directed to patients with refractory epilepsy to make them more familial with this therapeutic option might improve their degree of acceptance to it.