Time to Pediatric Epilepsy Surgery is Related to Disease Severity and Nonclinical Factors

In the March 6 issue of the journal Neurology, Doctors Baca and colleagues from the Departments of Neurology and Neurosurgery, Pediatrics, Psychiatry, Neuroradiology, Neuropathology from the Mattel Children’s Hospital at the University of California in Los Angeles, present an important study addressing the factors that lead to the timing for surgical intervention in kids. Data from 430 children younger than 18 years of age who had epilepsy surgery at the University of California, Los Angeles between 1986-2010 were analyzed to look for associations of clinical factors that led to what caused surgical intervention to occur in particular timing. The investigators found that a shorter time to surgery was associated with active and successfully treated infantile spasms:

• Daily or more seizures

• MRI before referral regardless of imaging findings

• Private insurance

• Hispanic ethnicity

Curiously, there were race and ethnic issues that influenced whether epilepsy surgery occurs with the shortest time to surgery surprisingly occurring for Hispanic children with private insurance. The investigators concluded that a shorter interval to surgical treatment was associated with greater epilepsy severity and insurance type consistent with other studies. However, a shorter time to treatment with having a brain MRI before referral and being Hispanic have not been reported previously. Clearly, more studies are needed in order to understand how generalizable the studies are.

What does this mean?

The study seems to suggest that the more seriously active children with epilepsy are more likely to be referred for surgery at one major center as compared to other groups. However, Hispanic ethinicity seems to increase the likelihood that epilepsy surgery will occur at an earlier point in time versus other groups. What this means is still uncertain but access to care as well as severity of the disease seems to be important factors that lead people for the attention of epilepsy surgery.