Multiple factors affect access to surgical care for youths with drug-resistant epilepsy

Key takeaways:

• Researchers identified more than 18,000 pediatric patients with drug-resistant epilepsy.
• Patients treated with anti-seizure medication only were more likely to be from underrepresented groups.

ORLANDO — For U.S. pediatric patients with drug-resistant epilepsy, disparities in surgical care exist with respect to age, socioeconomic and insurance variables, leading to differences in long-term outcomes, according to research.

“We measured the impact of treatments for drug-resistant epilepsy in children and ... there are disparities in who gets this care,” Sandi Lam, MD, MBA, lead study author and division chief of pediatric neurosurgery at Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a release related to a study presented at the American Epilepsy Society annual meeting.

As previous research has found that differences in long-term survival rates for pediatric patients with drug-resistant epilepsy were statistically significant, Lam and colleagues sought to examine factors associated with higher likelihood of survival in these populations when receiving surgical treatment.

They identified 18,292 patients aged 0 to 17 years (n = 10,240 treated with anti-seizure medications [ASM] only; n = 5,019 treated with ASMs plus vagus nerve stimulation [VNS]; n = 3,033 treated with ASMs plus cranial epilepsy surgery) from a Pediatric Health Information System data set lasting from January 2004 to December 2020 across 49 pediatric hospitals in the United States. Chi-square tests were utilized to determine associations between treatment time and preoperative factors such as treatment type, age, sex, race/ethnicity, insurance type, geographic region, epilepsy type and medical complexity (presence of pediatric complex chronic conditions [PCCCs]). 

According to results, significant differences were observed with respect to age, geographic region, race/ethnicity, presence of PCCCs, diagnosis and insurance type (P < 0.001). Patients given surgical intervention, either with VNS implantation or cranial epilepsy surgery, were 2 years older than those treated with ASMs only. Additionally, researchers found patients treated with ASM only were less likely to be reported as non-Hispanic white (51.78%), less likely have a focal/partial epilepsy diagnosis (8.74%) and less likely carry private medical insurance (35.82%).

“I think we can all agree it is not OK that certain groups of people are less likely to get surgical treatments that can help them live longer,” Lam said in a related release.

Reference:

• Surgery helps children with drug-resistant epilepsy live longer but those who are Black, Hispanic or on Medicaid less likely to get it. Published Dec. 1, 2023. Accessed Dec. 2, 2023.