Abstracts

Rationale: Clear evidence supports the benefits of surgery over continued drug therapy for patients with refractory focal epilepsy. Today, fewer than 2 % of those eligible embrace this viable treatment option, leaving the majority of refractory patients under treated. This serious issue raises concerns for standards of practice and challenges specialists in epilepsy care to address the treatment gap. Studies addressing patient perspectives on treatment choices are limited.
The current study explores the literature addressing perceptions of surgery in order to analyze motivation for surgery and how the consequences of treatment choices are perceived. Methods: A systematic search of the literature published between February 2003 and December 2013 was undertaken. The study period reflects the time immediately following the publication of the American Academy of Neurology Practice Guidelines and begins with the first paper to address patient attitudes towards treatment options for epilepsy. Analysis of this body of literature allowed for the extrapolation of major properties and overarching themes which supported the development of our explanatory model. A clinical case study is presented to illustrate major themes and the practical application of the model. Results: The case of a 63-year-old patient with seizures beginning in 1989 in association with a left anterior temporal cavernous angioma is presented. The view points of the clinic team and the patient herself serve to illustrate the tensions and consequences inherent in treatment decision- making. In this case the conflicts of fear, ignorance and symptom tolerance contributed to delayed surgery for more than 22 years. This response triad is conceptualized as the fulcrum upon which the complex process of justifying risk: benefit ratio pivots and is illustrated in the model. Conclusions: The application of our novel conceptual framework illustrates several principles that have the potential to advance our understanding of how treatment options, including but not limited to surgery, are prioritized by patients with refractory focal epilepsy. Studies are needed to address decision-making processes unique to a brain disorder such as epilepsy