Hudin N Jackson1, Nisha Gadgil1, I-Wen Pan2, Dave F Clarke3, Kathryn M Wagner1, Christopher A Cronkite1, Sandi Lam4. 1. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas. 2. Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas. 3. Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas. 4. Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: slam@luriechildrens.org.
Abstract
BACKGROUND: Despite documented efficacy of surgical treatment in carefully selected patients, surgery is delayed and/or underutilized in both adult and children with focal onset epilepsy. The reasons for surgical delay are often assumed or theorized, and studies have predominantly targeted the adult population. To focus on a more targeted pediatric population and to determine identifiable reasons for intervention, this study aimed to investigate time to epilepsy surgery among pediatric patients with medically intractable epilepsy associated with focal cortical dysplasia and to identify sociodemographic and clinical associations in time to epilepsy surgery. METHODS: We reviewed 96 consecutive pediatric patients who underwent surgery for medically intractable epilepsy with a diagnosis of focal cortical dysplasia. Descriptive statistics, univariate and multivariate analyses were conducted to study the association of sociodemographic variables of patients with focal cortical dysplasia and time to epilepsy surgery and postoperative seizure control. RESULTS: We identified that non-white patients on average had a longer duration of epilepsy before surgery and traveled shorter distances for care. Non-white patients were more likely to have government-funded insurance. Patients who traveled the shortest distance to the surgical center underwent epilepsy surgery at an older age. CONCLUSIONS: Sociodemographic factors of travel distance, insurance, and race influenced time to epilepsy surgery for children with focal cortical dysplasia. Further research is warranted to target barriers in access to subspecialty care and develop ways to identify earlier the patients who may benefit from evaluation and deployment of surgical intervention.
BACKGROUND: Despite documented efficacy of surgical treatment in carefully selected patients, surgery is delayed and/or underutilized in both adult and children with focal onset epilepsy. The reasons for surgical delay are often assumed or theorized, and studies have predominantly targeted the adult population. To focus on a more targeted pediatric population and to determine identifiable reasons for intervention, this study aimed to investigate time to epilepsy surgery among pediatric patients with medically intractable epilepsy associated with focal cortical dysplasia and to identify sociodemographic and clinical associations in time to epilepsy surgery. METHODS: We reviewed 96 consecutive pediatric patients who underwent surgery for medically intractable epilepsy with a diagnosis of focal cortical dysplasia. Descriptive statistics, univariate and multivariate analyses were conducted to study the association of sociodemographic variables of patients with focal cortical dysplasia and time to epilepsy surgery and postoperative seizure control. RESULTS: We identified that non-white patients on average had a longer duration of epilepsy before surgery and traveled shorter distances for care. Non-white patients were more likely to have government-funded insurance. Patients who traveled the shortest distance to the surgical center underwent epilepsy surgery at an older age. CONCLUSIONS: Sociodemographic factors of travel distance, insurance, and race influenced time to epilepsy surgery for children with focal cortical dysplasia. Further research is warranted to target barriers in access to subspecialty care and develop ways to identify earlier the patients who may benefit from evaluation and deployment of surgical intervention.
Authors: Fiona M Baumer; John R Mytinger; Kerri Neville; Christina Briscoe Abath; Camilo A Gutierrez; Adam L Numis; Chellamani Harini; Zihuai He; Shaun A Hussain; Anne T Berg; Catherine J Chu; William D Gaillard; Tobias Loddenkemper; Archana Pasupuleti; Debopam Samanta; Rani K Singh; Nilika S Singhal; Courtney J Wusthoff; Elaine C Wirrell; Elissa Yozawitz; Kelly G Knupp; Renée A Shellhaas; Zachary M Grinspan Journal: Ann Neurol Date: 2022-04-28 Impact factor: 11.274
Authors: Jacob Bernstein; Samir Kashyap; Michael W Kortz; Bishoy Zakhary; Ariel Takayanagi; Harjyot Toor; Paras Savla; Margaret R Wacker; Ajay Ananda; Dan Miulli Journal: Surg Neurol Int Date: 2021-11-02