Epilepsy center characteristics and geographic region influence presurgical testing in the United States

• Authors: Stephanie M Ahrens, The Ohio State University College of Medicine; Kristen H Arredondo, Dell Medical School; Anto I Bagić, University of Pittsburgh; Shasha Bai, Emory University; Kevin E Chapman, Phoenix Children's Hospital; Michael A Ciliberto, University of Iowa Stead Family Children’s Hospital; Dave F Clarke, Dell Medical School; Mariah Eisner, Nationwide Children’s Hospital; Nathan B Fountain, University of Virginia Health System; Jay R Gavvala, Baylor College of Medicine; Scott M Perry, Cook Children's Medical Center; Kyle C Rossi, Harvard Medical School; Lily C Wong-Kisiel, Mayo Clinic; Susan T Herman, Barrow Neurological Institute; Adam P Ostendorf, The Ohio State University College of Medicine
• Journal Title: Epilepsia
• Volume: Volume 64, Number 1
• Publisher: (publisher) | 2023-01-01, Pages 127-138
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1111/epi.17452
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: drug-resistant epilepsy (DRE); epilepsy monitoring unit (EMU); epilepsy surgery; Adult; Child; Humans; United States; Epilepsy; Drug Resistant Epilepsy; Tomography, Emission-Computed, Single-Photon; Positron-Emission Tomography; Research Design

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 US Census regional data. We used Wilcoxon rank-sum, Kruskal–Wallis, and chi-squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables. Results: The response rate was 100% with individual element missingness < 11% across 342 observations undergoing univariate analysis. A total of 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% confidence interval [CI] = 1.2–6.86; p =.018) and fluorodeoxyglucose–positron emission tomography (OR = 2.74, 95% CI = = 1.14–6.61; p =.025) more commonly. For centers in the Northeast (OR =.46, 95% CI =.23–.93; p =.031) and West (OR =.41, 95% CI =.19–.87; p =.022), odds of performing single-photon emission computerized tomography were 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 US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment.