University of Montréal School of Medicine, 1845 Avenue Fontaine, Laval, Montréal, QC H7T 1N8, Canada.
University of Montréal School of Medicine, 1845 Avenue Fontaine, Laval, Montréal, QC H7T 1N8, Canada.
Seizure. 2022 Nov;102:83-95. doi: 10.1016/j.seizure.2022.08.013. Epub 2022 Aug 31.
Up to 40% of pediatric epilepsy cases are drug-resistant and associated with neurocognitive, psychosocial, developmental comorbidities, and risk of early mortality. Epilepsy surgery (ES) may be considered after the failure of two anti-seizure medications (ASM) to provide patients with the opportunity to attain seizure freedom. However, only a small proportion of eligible patients receive surgical treatment. This scoping review aims to elucidate barriers to pediatric ES to understand the reasons for its underutilization.
Embase, PubMed, and Scopus were searched from inception through August 2022 for the following PICO terms: "pediatric", "parents", "epilepsy", "surgery", and "decision-making". Studies exploring barriers to ES were included and qualitatively synthesized. We adopted an inductive thematical approach, and barriers hindering ES were assigned to four thematic categories. PRISMA Sc-R guidelines were followed.
Of 3400 retrieved studies, 17 were included. Barriers to ES were classified into 4 categories. Parental barriers originating from misperception, lack of knowledge regarding surgical outcomes, and emotional vulnerability were highlighted in 76% of included studies. Physician-based barriers, including lack of clinical expertise, trust, and communication, leading to inadequate informed consent and referral to surgical evaluation, were described in 65% of articles. Patient-based barriers were reported in 47% of studies and included clinical characteristics modulating acceptance of ES. Only 18% of studies described healthcare system-based barriers, including intricate insurance policies not adapted to sociodemographic disparities.
This study highlights the complexity of barriers to pediatric ES. Our findings emphasize the need for multileveled strategies to increase the utilization of ES among eligible pediatric patients.
多达 40%的儿科癫痫病例是耐药的，并且与神经认知、心理社会、发育合并症以及早逝风险相关。癫痫手术 (ES) 可以在两种抗癫痫药物 (ASM) 治疗失败后考虑为患者提供无癫痫发作的机会。然而，只有一小部分符合条件的患者接受手术治疗。本范围综述旨在阐明儿科 ES 的障碍，以了解其未充分利用的原因。
从建库到 2022 年 8 月，通过 Embase、PubMed 和 Scopus 搜索了以下 PICO 术语的文献：“儿科”、“父母”、“癫痫”、“手术”和“决策”。纳入了探讨 ES 障碍的研究，并进行了定性综合。我们采用了归纳主题方法，将阻碍 ES 的障碍分配到四个主题类别中。遵循 PRISMA Sc-R 指南。
在 3400 篇检索到的研究中，有 17 篇被纳入。ES 的障碍分为 4 类。在纳入的研究中，76%强调了源于误解、缺乏对手术结果的了解以及情绪脆弱的父母障碍。在 65%的文章中描述了以医生为基础的障碍，包括缺乏临床专业知识、信任和沟通，导致知情同意不足和转诊进行手术评估。在 47%的研究中报告了患者为基础的障碍，包括影响接受 ES 的临床特征。只有 18%的研究描述了基于医疗保健系统的障碍，包括不适应社会人口差异的复杂保险政策。
本研究强调了儿科 ES 障碍的复杂性。我们的研究结果强调需要采取多层次策略来增加符合条件的儿科患者对 ES 的利用。
