Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques

Kristen H Arredondo; Stephanie M Ahrens; Anto I Bagić; Shasha Bai; Kevin E Chapman; Michael A Ciliberto; Dave F Clarke; Mariah Eisner; Nathan B Fountain; Jay R Gavvala; M Scott Perry; Kyle C Rossi; Lily C Wong-Kisiel; Susan T Herman; Adam P Ostendorf; NAEC Center Director Study Group

doi:10.1212/WNL.0000000000201526

Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques

Neurology. 2023 Feb 14;100(7):e719-e727. doi: 10.1212/WNL.0000000000201526. Epub 2022 Nov 2.

Authors

Affiliations

¹ From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX [email protected].
² From the Department of Pediatrics (K.H.A., S.M.A., A.P.O.), Division of Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; Department of Neurology (A.I.B.), University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), PA; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Barrow Neurologic Institute at Phoenix Children's Hospital (K.E.C.), AZ; Department of Pediatrics (M.A.C.), Stead Family Children's Hospital, University of Iowa City, IA; Department of Neurology (D.F.C.), Dell Medical School, University of Texas at Austin, TX; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), University of Virginia Health Sciences Center, Charlottesville; Department of Neurology (J.R.G.), Baylor College of Medicine, Houston, TX; Jane and John Justin Neurosciences Center (M.S.P.), Cook Children's Medical Center, Ft Worth, TX; Department of Neurology (K.C.R.), Division of Epilepsy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Department of Neurology (L.C.W.-K.), Mayo Clinic, Rochester, MN; and Barrow Neurological Institute (S.T.H.), Phoenix, AZ. Kristen H. Arredondo is currently at the Department of Neurology, Dell Medical School, The University of Texas at Austin, TX.

Abstract

Background and objective: Nearly one-third of persons with epilepsy will continue having seizures despite trialing multiple antiseizure medications. Epilepsy surgery may be beneficial in these cases, and evaluation at a comprehensive epilepsy center is recommended. Numerous palliative and potentially curative approaches exist, and types of surgery performed may be influenced by center characteristics. This article describes epilepsy center characteristics associated with epilepsy surgery access and volumes in the United States.

Methods: We analyzed National Association of Epilepsy Centers 2019 annual report and supplemental survey data obtained with responses from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Surgical treatment volumes were compiled with center characteristics, including US Census region. We used multivariable modeling with zero-inflated Poisson regression models to present ORs and incidence rate ratios of receiving a given surgery type based on center characteristics.

Results: The response rate was 100% with individual element missingness less than 4% across 352 observations undergoing univariate analysis. Multivariable models included 319 complete observations. Significant regional differences were present. The rates of laser interstitial thermal therapy (LITT) were lower at centers in the Midwest (incidence rate ratio [IRR] 0.74, 95% CI 0.59-0.92; p = 0.006) and Northeast (IRR 0.77, 95% CI 0.61-0.96; p = 0.022) compared with those in the South. Conversely, responsive neurostimulation implantation rates were higher in the Midwest (IRR 1.45, 95% CI 1.1-1.91; p = 0.008) and West (IRR 1.91, 95% CI 1.49-2.44; p < 0.001) compared with the South. Center accreditation level, institution type, demographics, and resources were also associated with variations in access and rates of potentially curative and palliative surgical interventions.

Discussion: Epilepsy surgery procedure volumes are influenced by US epilepsy center region and other characteristics. These variations may affect access to specific surgical treatments for persons with drug resistant epilepsy across the United States.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Drug Resistant Epilepsy* / epidemiology
Drug Resistant Epilepsy* / surgery
Epilepsy* / epidemiology
Epilepsy* / surgery
Health Facilities
Humans
Palliative Care
Seizures
United States / epidemiology