Prolonged intervals persist beyond epileptologist referral in corpus callosotomy: A referral odyssey analysis

Prolonged time to corpus callosotomy (CC) remains common; however, it remains unclear at which stages of the referral pathway prolonged intervals occur and which factors are associated with them. We aimed to characterize stage-specific intervals and identify factors associated with time to surgery.

We retrospectively analyzed 51 patients who underwent one-stage complete CC at a tertiary epilepsy center. Referral pathways were assessed across five milestones: seizure onset (T1), first non-epileptologist visit (T2), first epileptologist consultation (T3), comprehensive inpatient evaluation (T4), and CC (T5). Total and selected phase-specific intervals were examined using multivariable accelerated failure time models.

The median T1-T5 interval was 5.2 years (interquartile range [IQR], 3.5-13.8). Median phase-specific intervals were 1 day (IQR, 1-19 days) for T1-T2, 1.5 years (IQR, 0.1-3.5) for T2-T3, 1.8 years (IQR, 0.1-7.9) for T3-T4, and 0.3 years (IQR, 0.2-0.8) for T4-T5. Epileptic spasms were associated with a shorter T1-T5 interval (time ratio [TR], 0.62; 95% confidence interval [CI], 0.39-0.98), whereas tonic seizures (TR, 1.91; 95% CI, 1.09-3.36) and greater intellectual disability severity (TR, 1.61; 95% CI, 1.12-2.32) were associated with longer intervals. Geographic distance was associated with a longer T2-T3 interval (TR, 2.71; 95% CI, 1.60-4.59).

Prolonged intervals occurred both before and after epileptologist referral, particularly during the period before comprehensive inpatient evaluation, suggesting that referral alone may be insufficient and that comprehensive inpatient evaluation may be important in streamlining the pathway to CC.