Introduction: Epilepsy surgery for pediatric medically intractable epilepsy (MIE) has been shown to lead to improved neurocognitive outcomes. Despite this, epilepsy surgery for pediatric MIE is underutilized and those who do undergo surgery often experience lengthy delays in neurosurgical referral. Our aims were to retrospectively identify pediatric MIE patients in whom proper neurosurgical referral was not initiated and reasons for referral delay.
Methods: A retrospective review of pediatric neurology clinic patients from 9/2015 to 9/2016 was completed to identify pediatric MIE patients. Two pediatric epileptologists then reviewed these patients to determine those suitable for neurosurgical referral. Medical records were then compared to identify patients which had been properly referred for neurosurgical evaluation and those in whom neurosurgical referral had not been initiated. Demographic and clinical data were obtained; the Mann-Whitney U test was used to analyze ordinal data, Fisher’s exact test was used to analyze categorical data.
Results: 102 patients with a history of MIE were identified. Independent review by two pediatric epileptologists deemed 80 patients not appropriate for neurosurgical referral (the most common reasons being previous epilepsy surgery and epilepsy of genetic etiology) and 19 patients suitable for neurosurgical referral. Intra-rater reliability was high (k=0.94). Of these 19 patients, 5 were in the midst of neurosurgical evaluation while 14 patients had previously not been referred for neurosurgical evaluation. Significant factors in patients who had only been deemed appropriate for neurosurgical evaluation on ad-hoc review were age (Mann-Whitey U, p=0.03). Insignificant factors included gender, imaging characteristics, race, insurance status, and attending neurologist specialty.
Conclusions: Of 106 MIE patients, ad-hoc review identified 19 patients as warranting neurosurgical referral, 14 of which were newly identified patients. In comparing these 14 patients to the 5 patients in whom proper neurosurgical referral had been initiated, only advanced age was associated with delays in referral.
Patient Care: Our research will improve patient care in better identifying patients suitable for epilepsy surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of epilepsy surgery in MIE, 2) Discuss, in small groups the underutilization of epilepsy surgery, 3) Identify factors associated with delays in neurosurgical referral.