# Factors Limiting Access to Surgical Treatment of Focal Epilepsy in Kazakh Population

## TL;DR

The study finds that social and geographic factors, not medical need, determine access to epilepsy surgery in Kazakhstan.

## Contribution

It identifies specific socio-demographic and regional barriers to surgical treatment for focal epilepsy in the Kazakh population.

## Key findings

- Only 38.68% of eligible patients in Kazakhstan underwent epilepsy surgery.
- Married, employed, and rural patients are less likely to receive surgery.
- Geographic disparities suggest poor referral systems outside Astana.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Significant differences by marital status, social protection, and region indicate that social and geographic factors influence who receives surgical treatment, highlighting disparities in access to specialized care for people with drug-resistant focal epilepsy.Compared with non-operated patients, individuals with focal epilepsy who underwent surgery had a younger age at seizure onset, a longer duration of epilepsy, and earlier initiation of antiepileptic therapy, suggesting differences in referral timing and continuity of care that may influence the likelihood of receiving surgery.

Significant differences by marital status, social protection, and region indicate that social and geographic factors influence who receives surgical treatment, highlighting disparities in access to specialized care for people with drug-resistant focal epilepsy.

Compared with non-operated patients, individuals with focal epilepsy who underwent surgery had a younger age at seizure onset, a longer duration of epilepsy, and earlier initiation of antiepileptic therapy, suggesting differences in referral timing and continuity of care that may influence the likelihood of receiving surgery.

Public health significance—Why is this work of significance to public health?
Among patients with drug-resistant focal epilepsy identified as candidates for surgical treatment at the Epilepsy Center, only 38.68% underwent surgery. The work highlights the need to adopt a comprehensive approach to epilepsy management that preserves the work capacity and social participation of individuals with focal epilepsy.The finding that marital status, rural residence, employment, and especially region strongly influence the likelihood of receiving surgery shows that access to epilepsy treatment is shaped by social and geographic factors rather than medical need alone—indicating disparities that public health systems should address.

Among patients with drug-resistant focal epilepsy identified as candidates for surgical treatment at the Epilepsy Center, only 38.68% underwent surgery. The work highlights the need to adopt a comprehensive approach to epilepsy management that preserves the work capacity and social participation of individuals with focal epilepsy.

The finding that marital status, rural residence, employment, and especially region strongly influence the likelihood of receiving surgery shows that access to epilepsy treatment is shaped by social and geographic factors rather than medical need alone—indicating disparities that public health systems should address.

Public health implications—what are the key implications or messages for practitioners, policy makers and/or researchers in public health?
The need for prospective analysis and proactive measures in countries with rapidly developing technological capabilities and increasing barriers to the effective management of focal epilepsy.The need to accumulate personalized data from patients with focal epilepsy to support the development of technologies capable of predicting and modifying the course of the disease.

The need for prospective analysis and proactive measures in countries with rapidly developing technological capabilities and increasing barriers to the effective management of focal epilepsy.

The need to accumulate personalized data from patients with focal epilepsy to support the development of technologies capable of predicting and modifying the course of the disease.

Background/Objectives: Effective management represents a real opportunity to reduce the economic burden of focal epilepsy, which leads to the withdrawal of at least 0.7% of the working-age population from the labor force. The aim of this retrospective observational cross-sectional study is to identify barriers that limit access to surgical treatment for epilepsy among patients with focal epilepsy in Kazakh population. Methods: Medical reports from epileptologists on 3112 patients of the Epilepsy Center (Astana) in 2024 were reviewed. The study included original information on 1361 patients with a confirmed diagnosis of focal epilepsy, in accordance with ICD-10 codes G40.0–G40.2. Results: Timely detection of focal epilepsy was not associated with socio-demographic or regional factors in our sample. Logistic regression analysis showed that sex and social status did not affect whether patients underwent surgery. However, marital status, employment, and region were significant factors. Married and employed patients had higher odds of remaining non-operated. Among candidates for surgical treatment, 38.68% underwent surgery. Conclusions: The markedly higher odds of remaining non-operated outside Astana point to gaps in referral pathways and service availability, emphasizing the need for a comprehensive approach to managing focal epilepsy in countries undergoing rapid technological development.