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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization

Published on: September 20, 2024

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Disparities in pediatric drug-resistant epilepsy care

Melissa A LoPresti1, Lu Zhang1, Sandi Lam2

  • 1Division of Pediatric Neurosurgery, Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|February 16, 2023
PubMed

Insights

Disparities exist in epilepsy surgery referral for children with drug-resistant epilepsy (DRE). Factors like race, insurance, and region influence access to surgical evaluation and treatment, necessitating targeted outreach strategies.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Health Services Research

Background:

  • Drug-resistant epilepsy (DRE) affects a significant portion of children with epilepsy, often necessitating surgical evaluation.
  • Many children with DRE experience delays or never receive a referral for surgical intervention.
  • Understanding referral patterns is crucial for improving access to epilepsy surgery.

Purpose of the Study:

  • To identify factors associated with epilepsy surgery referral in pediatric patients with DRE in the USA.
  • To characterize disparities in access to epilepsy surgery evaluation and treatment.
  • To recognize areas for improvement in care for children with DRE.

Main Methods:

  • Analysis of the Pediatric Health Information System (PHIS) Database for pediatric patients diagnosed with DRE (2004-2020).
  • Comparison of treatment groups: antiseizure medications (ASMs) only, ASMs + vagus nerve stimulation (VNS), and ASMs + cranial epilepsy surgery.
  • Statistical analysis (chi-square tests) of preoperative factors including age, sex, race/ethnicity, insurance, geographic region, patient type, epilepsy type, and pediatric complex chronic conditions (PCCCs).

Main Results:

  • A total of 18,292 patients were identified across treatment groups.
  • Significant variations in referral and treatment were observed based on age, census region, race/ethnicity, patient type, PCCCs, diagnosis, and insurance type (p < 0.001).
  • Patients receiving surgical treatment (VNS or epilepsy surgery) were older and less likely to be non-Hispanic white, have private insurance, or reside in the Midwest.

Conclusions:

  • Significant disparities in epilepsy surgery referral and management exist for children with DRE in the USA.
  • These disparities are likely linked to access to care and social determinants of health.
  • Focused outreach strategies are recommended to mitigate disparities and improve outcomes for children with DRE.
Abstract

Keywords:
DisparitiesEpilepsyPediatricSurgical epilepsy

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