Clinician knowledge gaps in epilepsy surgery: An international survey across 18 countries or regions in Asia–Oceania

OBJECTIVE: This study was undertaken to assess clinicians' knowledge of epilepsy surgery across Asia-Oceania and identify individual- and country- or region-level factors associated with this knowledge, to inform strategies addressing the epilepsy surgery treatment gap. METHODS: We conducted a multinational, cross-sectional, web-based survey of clinicians involved in epilepsy care across 18 countries or regions in Asia-Oceania (May-September 2024). The primary outcome was an epilepsy surgery knowledge score (range = 0-12), derived from 12 multiple-choice items covering indications for surgery, referral timing, understanding of surgical procedures, misconceptions about antiseizure medication efficacy, and perceived contraindications (e.g., electroencephalographic/magnetic resonance imaging findings, eloquent cortex, memory risk, psychiatric comorbidity, and intellectual disability). Linear mixed-effects models were used to identify individual-level predictors of knowledge, with country or region modeled as a random intercept. Ancillary analyses examined correlations between country- or region-level knowledge effects and academic activity related to epilepsy. RESULTS: A total of 809 clinicians were included, with respondents primarily from India (n = 204), China (n = 194), and Japan (n = 93). The mean knowledge score was 7.3 ± 2.9, with item-level correct response rates ranging from 11.2% to 87.6%. Higher knowledge was independently associated with being an epileptologist or neurosurgeon, working at a center with an epilepsy surgery program, and higher epilepsy case volume. Lower knowledge was observed among clinicians outside core neurological specialties. Significant country- or region-level variation persisted after adjustment and correlated with national academic activity in epilepsy surgery and epilepsy awareness. SIGNIFICANCE: Clinician knowledge of epilepsy surgery varies substantially across Asia-Oceania. Although targeted education is necessary, structural factors such as the availability of epilepsy surgery programs and national academic engagement also appear critical for translating knowledge into access. Multilevel strategies that integrate education with health-system strengthening are needed to meaningfully reduce the epilepsy surgery knowledge and treatment gaps.