Plateau Physicians Show Significant Epilepsy Knowledge Gaps

A cross-sectional study published in Acta Epileptologica reveals significant disparities in epilepsy knowledge among physicians working in the plains and plateau regions of western China. The research, conducted between March and April 2023, compared medical professionals in Chengdu, a relatively developed plains city, with those in Lhasa and Xichang, which are situated on the Qinghai-Tibet Plateau. The findings indicate that physicians in the less developed plateau regions scored significantly lower on multiple key aspects of epilepsy care, including diagnosis, treatment, and specialized management. This study appears to be the first parallel comparison of these two distinct geographical and developmental contexts within western China, highlighting persistent gaps in healthcare expertise that may affect patient outcomes.

The study was motivated by the substantial burden of epilepsy worldwide, which affects approximately 50 million people. In China, healthcare resources are unevenly distributed, with medical infrastructure and education generally more advanced in the northern, eastern, and southeastern regions compared to the western areas. Within western China itself, the plains area around Chengdu is relatively more developed and hosts most of the region’s epilepsy centers. In contrast, the Tibetan Plateau faces severe resource constraints, with nearly 90% of epilepsy patients reportedly not receiving effective treatment due to a lack of adequate healthcare resources and properly trained staff. These disparities suggest that targeted training and capacity-building interventions are necessary to narrow the treatment gap.

Researchers invited physicians who were signing up for voluntary training courses on the diagnosis, long-term management, preoperative evaluation, and surgical treatment of epilepsy to participate in the survey. Participants were required to provide informed consent and complete an online questionnaire before the training began. The questionnaire was designed specifically for this study based on consensus guidelines from the International League Against Epilepsy (ILAE) and relevant research literature. It collected general information about respondents and their workplace, along with 30 items assessing their awareness or knowledge of key aspects of epilepsy diagnosis, treatment, and management.

Of the 349 questionnaires received, 24 were excluded because they contained incomplete responses, leaving 325 participants in the final analysis. The sample included 146 respondents from the plains region and 179 from the plateau region. The proportion of female participants was higher than that of male participants in both regions, with 64.38% in the plains and 67.04% in the plateau, a difference that was not statistically significant. Approximately 90% of respondents in both regions worked in tertiary hospitals. However, there were significant differences in professional composition: just under half of the plains staff worked at the level of specialist, whereas just over half of the plateau staff were residents. A significantly higher proportion of plains staff specialized in neurology compared to their plateau counterparts.

The overall questionnaire scores revealed a significant advantage for the plains group, which reported a mean score of 85.5 compared to 75.0 for the plateau group. The questionnaire utilized a 5-point Likert scale for most questions, ranging from “completely unaware” to “extremely aware,” with a total possible score ranging from 27 to 138. Specific modules showed marked discrepancies. For instance, physicians in the plateau region were significantly more likely to hold erroneous ideas about the diagnosis of epilepsy. A higher percentage of plateau physicians believed that a first seizure warranted the immediate prescription of anti-seizure medication, and that a first seizure could indicate epilepsy, compared to physicians in the plains region.

Conversely, significantly fewer plateau physicians were aware that electroencephalography (EEG) or computed tomography (CT)/magnetic resonance imaging (MRI) should be carried out when deciding whether initial seizures could be due to epilepsy or another condition. The plains group also demonstrated significantly greater awareness of specific EEG testing procedures, including the “EEG 10–20” system, hyperventilation, flash stimulation, and eye opening/closing. Regarding drug-resistant epilepsy, the plains group reported significantly greater knowledge about its diagnosis and the concept of a defined daily dose for anti-seizure medications. This distinction is clinically important because failure to control epilepsy with drugs does not necessarily mean the condition is drug-resistant; such failure can occur when drugs are administered at doses below 50% of the defined daily dose.

In the area of preoperative evaluation and surgical treatment, the plains group showed significantly greater awareness of the usefulness of MRI and single photon emission computed tomography (SPECT) for assessing epilepsy patients before surgery. However, both groups showed equally low awareness of magnetoencephalography (MEG) for this purpose. While plains physicians had a better understanding of the need for surgery to treat drug-resistant epilepsy involving hippocampal sclerosis or focal cortical dysplasia, both regions exhibited relatively low knowledge about evaluation based on intracranial electrodes and standardized sequences for MRI of patients with epilepsy. The plains group also reported significantly more knowledge of deep brain stimulation (DBS) than the plateau group, although both groups reported similar knowledge of vagus nerve stimulation (VNS) and responsive neurostimulation (RNS).

Significant gaps were also identified in the plateau group’s knowledge of status epilepticus, a medical emergency that requires early diagnosis and standardized treatment to control the condition in over two-thirds of epilepsy patients. Additionally, plateau physicians showed significant deficits in their understanding of comorbidities in epilepsy and the associated risk of sudden death. The study further highlighted significant knowledge deficits among plateau physicians regarding the management of epilepsy during pregnancy. This management may require adjusting the dose of folic acid supplementation, anti-seizure medication, and breastfeeding schedules, as pregnancy involves hormonal changes that can alter seizure mechanisms and drug efficacy, while drugs can potentially harm the fetus through direct teratogenic effects.

To validate the role of specialized training, the researchers compared the epilepsy knowledge levels of neurologists specifically in the two regions. They selected 108 neurologists from the plains region and 23 from the plateau region for this subgroup analysis. The difference in total questionnaire scores between these two groups of specialists was not statistically significant, with scores of 89 for the plains group and 96 for the plateau group. Similarly, the scores for each individual module showed no significant differences between the neurologists in the two regions. This suggests that when comparing like-for-like specialists, the knowledge gap narrows considerably, implying that the broader disparities observed in the full sample are largely driven by the lower proportion of specialized neurologists in the plateau region.

The authors attribute the lag in plateau regions primarily to a shortage of specialized neurologists and the concentration of resources in the plains. Until 2016, China had only 37 specialized epilepsy centers per million patients, mainly concentrated in developed regions, compared to 75 per million in the United States in 2019. The study emphasizes that while progress has been made in epilepsy care in undeveloped regions of China, this development has not benefited all regions equally. The diagnosis and long-term treatment of epilepsy in plateau regions continue to require enhanced training and policy development to address these persistent inequalities.

Despite the significant findings, the study has several limitations that should be considered when interpreting the results. The sample was relatively small, and recruiting bias may be present because all participants were physicians who had signed up for epilepsy training courses. The questionnaire did not collect information on participants’ age or educational background, instead substituting factors such as employment duration and specialty practice. Furthermore, as a cross-sectional study, the design prevents the researchers from drawing conclusions about changes in awareness or knowledge over time as a result of training or capacity-building interventions. The authors recommend that targeted training and capacity-building interventions be implemented to bridge these gaps, with their effectiveness rigorously evaluated through longitudinal studies in the future.

Subject of Research: Epilepsy knowledge disparities among physicians in western China

Article Title: Epilepsy awareness among physicians in plains and plateau regions of western China: a cross-sectional study

Article References: Xiao, X., Xiao, J., Zhou, C., Pan, C., Hao, Y., Jin, M., Han, M., Jiang, S., Liu, J., Tang, Y., Wu, X., Yan, B., & Hao, X. (2026). Epilepsy awareness among physicians in plains and plateau regions of western China: a cross-sectional study. Acta Epileptologica, 8(1), Article 11. https://doi.org/10.1186/s42494-026-00251-9

Image Credits: AI Generated

DOI: 10.1186/s42494-026-00251-9

Keywords: Epilepsy, Healthcare Disparities, Western China, Cross-sectional Study, Medical Education, Neurology, Plateau Region, Plains Region, Clinical Knowledge, Public Health, awareness, physicians