Journal article
Epilepsy center characteristics and geographic region influence presurgical testing in the United States
Epilepsia, Vol.64(1), pp.127-138
01/2023
DOI: 10.1111/epi.17452
PMCID: PMC10099541
PMID: 36317952
Abstract
OBJECTIVE Persons with drug-resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy. METHODS We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and U.S. Census regional data. We used Wilcoxon rank-sum, Kruskal-Wallis, and chi-square tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios of significant variables. RESULTS The response rate was 100% with individual element missingness less than 11% across 342 observations undergoing univariate analysis. 278 complete observations were included in the multivariable models and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR 2.87, 95% CI 1.2 - 6.86, p = 0.018) and FDG-PET (OR 2.74, 95% CI 1.14- 6.61, p = 0.025) more commonly. For centers in the Northeast (OR 0.46, 95% CI 0.23-0.93, p = 0.031) and West (OR 0.41, 95% CI 0.19-0.87, p = 0.022), odds of performing SPECT was lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume and resources were also associated with varying individual testing rates. SIGNIFICANCE Presurgical testing for drug resistant epilepsy is influenced by U.S. geographic region and other center characteristics. These findings have potential implications for comparing outcomes between U.S. epilepsy centers and may inject disparities in access to surgical treatment.
Details
- Title: Subtitle
- Epilepsy center characteristics and geographic region influence presurgical testing in the United States
- Creators
- Stephanie M Ahrens - Nationwide Children's HospitalKristen H Arredondo - 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
- Epilepsia, Vol.64(1), pp.127-138
- DOI
- 10.1111/epi.17452
- PMID
- 36317952
- PMCID
- PMC10099541
- NLM abbreviation
- Epilepsia
- ISSN
- 0013-9580
- eISSN
- 1528-1167
- Grant note
- DOI: 10.13039/100007520, name: Nationwide Children's Hospital, award: 45141‐0001‐0321
- Language
- English
- Electronic publication date
- 11/01/2022
- Date published
- 01/2023
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984309751402771
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