Barriers to care in epilepsy surgery clinics in Latin America: a systematic review of social-economic impact.

Epilepsy surgery remains underutilized in Latin America despite its proven effectiveness for drug-resistant epilepsy. Structural and socioeconomic barriers may contribute to limited access and delayed intervention. To systematically evaluate the clinical characteristics, surgical outcomes, and socioeconomic barriers to accessibility associated with epilepsy surgery in Latin America. A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, ScienceDirect, Web of Science, and SciELO. Studies were included if they reported original data on epilepsy surgery in Latin American populations. Data on demographics, epilepsy type, and surgical outcomes were extracted and analyzed descriptively. Barriers such as geographic centralization, economic constraints, lack of specialized centers, and limited diagnostic infrastructure were also identified and examined. Of 103 initial records, 10 studies met all inclusion criteria. Most were retrospective observational studies from Colombia, Brazil, Mexico, and Chile. The mean age at surgery was 30.3 years, with an average diagnostic-to-surgery delay of 17.1 years. Mesial temporal lobe epilepsy was the most common subtype. Seizure freedom (Engel Class I) was achieved in 43.7% to 85% of cases. However, only 3.8% of eligible patients underwent surgery in some cohorts. Barriers included geographic centralization, economic constraints, lack of specialized centers, limited diagnostic infrastructure, cultural stigma, and under-referral from physicians. Quality-of-life improvements and psychosocial reintegration were observed postoperatively, yet disparities in access persisted. Despite favorable surgical outcomes, epilepsy surgery in Latin America remains significantly delayed and centralized. Health system limitations and socioeconomic inequities continue to restrict timely and equitable access. Regional policies must prioritize early referral pathways, surgical infrastructure, and financial protection to reduce the epilepsy treatment gap.