Time to pediatric epilepsy surgery is related to disease severity and nonclinical factors

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Health Services Research

Background:

• Epilepsy surgery evaluation and treatment timelines vary significantly in pediatric populations.
• Understanding factors influencing delays in surgical care is crucial for improving patient outcomes.

Purpose of the Study:

• To identify clinical and nonclinical factors associated with the time from epilepsy onset to surgical evaluation and treatment in children undergoing epilepsy surgery.
• To analyze associations between epilepsy severity, pre-referral brain MRI, and sociodemographic characteristics with time to surgery.

Main Methods:

• Retrospective analysis of 430 children (<18 years) who underwent epilepsy neurosurgery at UCLA (1986-2010).
• Multivariable Cox proportional hazards models were employed to assess associations.
• Factors analyzed included clinical severity, pre-referral brain MRI, and sociodemographic characteristics.

Main Results:

• Shorter time to surgery was associated with active infantile spasms, daily or more seizures, and prior MRI regardless of findings.
• Private insurance and Hispanic ethnicity were also linked to shorter intervals to surgical treatment.
• A significant interaction between race/ethnicity and insurance type was observed, with the shortest time to surgery for Hispanic children with private insurance.

Conclusions:

• Epilepsy severity and insurance type are key factors influencing timely surgical treatment, aligning with existing research.
• Unexpectedly, undergoing a brain MRI before referral and Hispanic ethnicity were associated with shorter treatment intervals, warranting further investigation.
• Potential explanations for MRI association include provider/parent knowledge; for Hispanic ethnicity, it may relate to increased access or referral patterns at the institution.