Awareness and Attitudes of General Physicians’ toward Epilepsy Surgery

Abstract

Objective: Over 30% of the people with epilepsy (poW) are resistant to medications. There is a significant surgical gap in India as only a minority of candidates for epilepsy surgery is referred for surgical evaluation. We investigated general physicians' views on referral of epilepsy patients for further evaluation and epilepsy surgery. Materials and Methods: A questionnaire was developed and validated by a pilot study. The electronic questionnaire was sent out to general physicians, practicing in towns of southern India. We collected response from 140 doctors. Results: Sixty-nine percent of the respondents worked in government hospitals. Eighty-four percent of them felt MRI and EEG were essential for epilepsy evaluation. But 55% felt CT brain and X-ray were essential for epilepsy evaluation. On commenting about treatment, 85% felt other modalities in addition to medications were necessary for epilepsy treatment. Psychotherapy was the commonest add-on for antiepileptics. Seventy-six percent felt resective brain surgery was an option for PoW. Only 39% considered vagal stimulation as a treatment option. Only 24% of the respondents knew the correct definition of drug-resistant epilepsy. More than two thirds were willing to refer their epilepsy patients to neurologist. Regarding safety of epilepsy surgery safety, 67% did not have any experience and only 24% felt it was safe. Only 36% felt epilepsy surgery had high cost-effectiveness in long-term perspective of eligible patients. Only 11% felt the epilepsy care in India was adequate and 17% felt it was grossly inadequate. Forty-seven percent of the physicians felt specialized epilepsy training program to doctors of primary health center and district hospitals would improve epilepsy care in India. Conclusion: Most of the physicians had good understanding about inadequacies of epilepsy care in India. They felt the need for special training program for improving epilepsy care in India. Uncertainties about benefits of epilepsy surgery among referring general physicians may contribute to the delay in referral to epilepsy surgery.