Abstracts

Rationale: Rationale: The underutilization of epilepsy surgery (ES) is well documented, yet reasons for this remain poorly understood. While neuromodulation offers a viable treatment option for drug-resistant epilepsy, these therapies underscore the urgency to address reasons that patients do not embrace ES. Although studies highlight physicians and patient perspectives on ES, no study addresses the views of Advanced Practice Providers (APPs). APPs are increasingly involved in treatment decision-making and neuromodulation clinics, we aim to identify barriers to ES and gaps in patient education from perspectives of APPs.

Methods: A 9-item survey on barriers encountered during the ES evaluation and key topics for patient counseling was used. The survey was developed by an epilepsy APP working group. The survey was emailed to APPs at level 4 US epilepsy centers between Feb and May 2021.

Results: A total of 50 surveys were sent and 30 were returned. Our survey identified patient hesitation and patients falling off the treatment radar as the largest barriers in ES evaluation process (Fig 1). Specifically, patient hesitations including fear of functional deficit after resection, continued seizures and inability to eliminate antiseizure medications(ASM) after neuromodulation were highlighted. Clinical implications of our findings include practical suggestions for better-educating patients of the surgical options as soon as they become refractory to ASM.

Conclusions: APPs play a vital role in informing patients about ES and neuromodulation options early in the process of epilepsy evaluation. APP perspective contributes a distinct viewpoint with potential on improving patient acceptance with treatment options, reducing delays and promoting timely treatment. Patient hesitation around treatment options can be addressed with more informative counseling earlier in the ES evaluation, starting at their first visit. Reviewing the functional mapping procedure and recovery will assure a patient that precautions are taken and patients normally recover without long-term deficit¹. Seizure frequency and severity reductions, quality of life improvements and lack of cognitive decline found with neuromodulation can be highlighted^2-4 to address concerns about lack of seizure freedom and ASMs. It is reported that patients living with epilepsy for years often underrate their seizure severity and may grow ambivalent about pursuing further treatment⁵. The value of intervening with surgery or neuromodulation earlier in the course of a patient’s epilepsy has been described in the literature^6,7. During counseling sessions, long-term consequences of continued seizures should be reviewed including SUDEP, worsening seizures and cognition, depression, and mood decline^8-11.
References:
1 Gleissner U et al Brain, 2005
2 Shah V et al Practical Neurology 2019
3 Ergene E et al Epilepsy and Behavior, 2001
4 Meador K et al Epilepsy and Behavior, 2015
5 Dewar SR et al Epilepsy and Behavior, 2020
6 Engel J et al JAMA, 2012
7 Loring D et al Epilepsy and Behavior, 2021
8 Sperling MR Epilepsy Currents, 2001
9 Sperling MR CNS Specr, 2004
10 Rijckevorsel K Seizure, 2009
11 Jagadheesan K et al Seizure, 2003

Funding: Please list any funding that was received in support of this abstract.: None.