Access to surgery for paediatric patients with medically refractory epilepsy: a systems analysis

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Health Systems Analysis

Background:

• Medically refractory epilepsy (MRE) in children necessitates comprehensive evaluation for surgical candidacy.
• Access to timely surgical intervention is crucial for improving seizure control and functional outcomes in pediatric epilepsy patients.

Observation:

• A systems analysis of pediatric epilepsy surgery access in Ontario revealed significant delays in the patient pathway.
• Only 40% of children discussed at seizure conferences were deemed surgical candidates, with a median delay of 4.6 years from first seizure to referral.

Findings:

• Referral rates for surgical assessment are critically low, with less than 2% of estimated eligible children in Ontario being evaluated.
• The time from initial referral to surgery can range from 1.1 to 1.6 years, depending on the need for invasive monitoring.

Implications:

• The current healthcare system in Ontario fails to provide equitable access to epilepsy surgery for a majority of children with MRE.
• A redesign of the health system is urgently needed to ensure consistent and just access to evidence-based epilepsy surgery care.