Challenges to Epilepsy Surgery Referral in Mexico: Results from a Nationwide Survey of Primary Care Physicians and Specialists

Introduction: Approximately 30% of patients with epilepsy are candidates for surgical evaluation, yet only about 1% of those with drug-resistant epilepsy (DRE) receive such an assessment. To enhance referral rates both in the short and long term, it is crucial to understand the current landscape in Mexico.

Methods: A nationwide survey was conducted to evaluate the knowledge and opinions of Primary Care Physicians and Specialists regarding epilepsy surgery. The survey was distributed via email, adhering to the International League Against Epilepsy (ILAE) definition of DRE as the benchmark for surgical evaluation. Differences between general practitioners and neurosrugerons were calculated utilizing a Chi-square test.

Results: We received 262 completed surveys, including 137 responses from General Practitioners and 29 from Neurosurgeons, with a median respondent age of 31 years (IQR 27-42.5). Among General Practitioners, 77.4% (n=106) were unaware of an epilepsy surgery referral center in their area, compared to 51.7% (n=15) of Neurosurgeons (p=0.0047). Additionally, 27.7% of General Practitioners (n=38) and 27.6% of Neurosurgeons (n=8) were unfamiliar with the ILAE definition of drug-resistant epilepsy (DRE) for recommending surgical evaluation (p=0.98). Moreover, 50.4% of General Practitioners viewed epilepsy surgery as a high-risk procedure (n=69), compared to 13.8% of Neurosurgeons (N=4). A higher proportion of general practitioners perceived epilepsy surgery as a high-risk procedure compared to neurosurgeons (p=0.0003).

Conclusion : There is a significant underreferral of patients with epilepsy for surgical evaluation. This national survey highlights a critical barrier: the gap in knowledge from General Practitioners to Specialists. To improve care for patients with epilepsy, national awareness campaigns should be implemented to educate physicians about the benefits and risks of epilepsy surgery, aiming to dispel misconceptions and ultimately increase appropriate referrals.