Few People with Drug-Resistant Epilepsy Receive Recommended Neurodiagnostic Evaluation

Comprehensive neurodiagnostic evaluation is significantly underused by clinicians managing patients with drug-resistant epilepsy (DRE), as shown in a new study published in JAMA Neurology. The gap in patients receiving evaluation was present across 3 large US health care databases. For patients with DRE, comprehensive neurodiagnostic evaluation (NDE) is recommended by interdisciplinary practice parameters, highlighting the significance of the identified underutilization.

The retrospective cross-sectional study included data from 3 cohorts:

• The MarketScan MultiState Medicaid (MDCD) database of Medicaid-insured individuals (n=33,542)
• The MarketScan Commercial Claims and Encounters (CCAE) database of employersponsored private health care plans (n=22,496)
• The Columbia University Medical Center (CUMC) electronic health record (EHR)–derived database (n=2741)

Participants were included in the analysis if they met validated criteria for having prevalent DRE between January 1, 2015, and April 1, 2020. Statistical analysis was used to identify the proportion of participants who received the recommended comprehensive evaluation. Three categories of neurodiagnostic studies critical to presurgical evaluation were included in the primary outcome analysis: MRI of the brain, video electroencephalography (EEG) study, and neuropsychological evaluation.

According to the study results, a significant percentage of individuals with DRE did not receive recommended NDE within 2 years of a clinical encounter:

• Only 4.5% (n=1520) of participants in the MDCD cohort received NDE
• Only 8.0% (n=1796) of participants in the CCAE cohort received NDE
• Onlly 14.3% (n=393) of participants in the CUMC cohort received NDE

Factors associated with higher odds of receiving the comprehensive evaluation across all three cohorts included a greater number of outpatient and non-emergency inpatient epilepsy visits as well as having focal rather than generalized epilepsy. The authors conclude that this significant gap in the use of recommended diagnostic studies to evaluate patients with DRE may contribute to the underuse of potentially curative epilepsy surgery.