Journal article
Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques
Neurology, Vol.100(7), pp.e719-e727
02/14/2023
DOI: 10.1212/WNL.0000000000201526
PMCID: PMC9969912
PMID: 36323517
Abstract
OBJECTIVE Nearly one third of persons with epilepsy will continue having seizures despite trialing multiple antiseizure medications. Epilepsy surgery may be beneficial in these cases, and evaluation at a comprehensive epilepsy center is recommended. Numerous palliative and potentially curative approaches exist, and types of surgery performed may be influenced by center characteristics. This article describes epilepsy center characteristics associated with epilepsy surgery access and volumes in the U.S. METHODS We analyzed National Association of Epilepsy Centers 2019 annual report and supplemental survey data obtained with responses from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Surgical treatment volumes were compiled with center characteristics, including U.S. Census region. We used multivariable modeling with zero-inflated Poisson regression models to present odds ratios and incidence rate ratios of receiving a given surgery type based on center characteristics. RESULTS The response rate was 100% with individual element missingness less than 4% across 352 observations undergoing univariate analysis. Multivariable models included 319 complete observations. Significant regional differences were present. Rates of laser interstitial thermal therapy (LITT) were lower at centers in the Midwest (IRR 0.74, 95% CI 0.59-0.92; p = 0.006) and the Northeast (IRR 0.77, 95% CI 0.61-0.96; p = 0.022) compared to those in the South. Conversely, responsive neurostimulation (RNS) implantation rates were higher in the Midwest (IRR 1.45, 95% CI 1.1-1.91; p = 0.008) and West (IRR 1.91, 95% CI 1.49-2.44; p < 0.001) compared to the South. Center accreditation level, institution type, demographics, and resources were also associated with variations in access and rates of potentially curative and palliative surgical interventions. INTERPRETATION Epilepsy surgery procedure volumes are influenced by U.S. epilepsy center region and other characteristics. These variations may impact access to specific surgical treatments for persons with drug resistant epilepsy across the U.S.
Details
- Title: Subtitle
- Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques
- Creators
- Kristen H Arredondo - Nationwide Children's HospitalStephanie M Ahrens - Nationwide Children's HospitalAnto I Bagic - Comprehensive Epilepsy CenterShasha Bai - Emory UniversityKevin E Chapman - Phoenix Children's HospitalMichael A Ciliberto - University of IowaDave F Clarke - The University of Texas at AustinMariah Eisner - Nationwide Children's HospitalNathan B Fountain - University of VirginiaJay R Gavvala - Baylor College of MedicineM S Perry - Cook Children's Medical CenterKyle C Rossi - Beth Israel Deaconess Medical CenterLily C Wong-Kisiel - Mayo ClinicSusan T Herman - Barrow Neurological InstituteAdam P Ostendorf - Nationwide Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.100(7), pp.e719-e727
- DOI
- 10.1212/WNL.0000000000201526
- PMID
- 36323517
- PMCID
- PMC9969912
- NLM abbreviation
- Neurology
- eISSN
- 1526-632X
- Language
- English
- Electronic publication date
- 11/02/2022
- Date published
- 02/14/2023
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984309651802771
Metrics
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