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Epilepsy Research and Treatment
Volume 2013 (2013), Article ID 309284, 13 pages
http://dx.doi.org/10.1155/2013/309284
Research Article

Epilepsy Surgery: Factors That Affect Patient Decision-Making in Choosing or Deferring a Procedure

1Department of Neurology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, FWC, Milwaukee, WI 53226, USA
2Johns Hopkins School Public Health, JHU, Baltimore, MD 21224, USA
3Department of Neurology, University of Medicine and Dentistry of New Jersey, New Brunswick, NY 08901, USA
4Department of Neurology, Penn Epilepsy Center, University of Pennsylvania, HUP, Philadelphia, PA 19104, USA

Received 16 April 2013; Accepted 2 August 2013

Academic Editor: Giangennaro Coppola

Copyright © 2013 Christopher Todd Anderson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Surgical resection for well-selected patients with refractory epilepsy provides seizure freedom approximately two-thirds of the time. Despite this, many good candidates for surgery, after a presurgical workup, ultimately do not consent to a procedure. The reasons why patients decline potentially effective surgery are not completely understood. We explored the socio cultural, medical, personal, and psychological differences between candidates who chose (n = 23) and those who declined surgical intervention (n = 9). We created a novel questionnaire addressing a range of possible factors important in patient decision making. We found that patients who declined surgery were less bothered by their epilepsy (despite comparable severity), more anxious about surgery, and less likely to listen to their doctors (and others) and had more comorbid psychiatric disease. Patients who chose surgery were more embarrassed by their seizures, more interested in being “seizure-free”, and less anxious about specific aspects of surgery. Patient attitudes, beliefs, and anxiety serve as barriers to ideal care. These results can provide opportunities for education, treatment, and intervention. Additionally, patients who fit a profile of someone who is likely to defer surgery may not be appropriate for risky and expensive presurgical testing.