Study Uncovers Significant Disparities in Surgical Treatment for Drug-Resistant Epilepsy

According to results presented at the 2023 American Epilepsy Society (AES) Annual Meeting, Black and Hispanic children and those on Medicaid are less likely to receive epilepsy surgery for the treatment of drug-resistant epilepsy than non-Hispanic White children and those with private insurance. Researchers also found that epilepsy surgery was associated with longer survival in children with drug-resistant epilepsy.

The study took place from 2004 to 2020 across 49 US pediatric hospitals and included 18,292 children who received treatment for drug-resistant epilepsy. Within this study population, 10,240 children were treated with anti-seizure medications (ASMs) only, 5019 received ASMs and vagus nerve stimulation (VNS), and 3033 received ASMs and cranial epilepsy surgery. Researchers found a difference in the distribution of race, ethnicity, and insurance among these treatment cohorts.

• A higher proportion of patients in the ASM/cranial epilepsy surgery cohort had private insurance compared to the ASM only and ASM/VGS cohorts.  
• The proportion of non-Hispanic White individuals was significantly larger than that of other races and ethnicities in the cranial epilepsy surgery and ASM/VNS cohorts.

The inverse probability of treatment weighing (IPTW)-adjusted probabilities of surviving beyond 10 years were 89.27% (95% CI, 87.71-90.85) for the ASM only cohort, 92.65% (95% CI, 90.62-94.72) for the ASM/VNS cohort, and 98.45% (95% CI, 97.53-99.38) for the cranial epilepsy surgery cohort. Furthermore, the IPTW-adjusted hazard ratio for overall death was 0.60 (95% CI, 0.50-0.74) for the ASM/VNS cohort and 0.19 (0.10-0.33) for the cranial epilepsy surgery cohort.

Researchers found that after 10 years of treatment, those in the ASM/VNS cohort were 35% more likely to be alive and those in the cranial epilepsy surgery cohort were 83% more likely to be alive than the ASM only cohort.

Sandi Lam, MD, MBA, lead author of the study and division chief of pediatric neurosurgery at Ann & Robert H. Lurie Children’s Hospital of Chicago notes “For the first time, we measured the impact of treatments for drug-resistant epilepsy in children and found that surgical care is associated with longer survival and yet there are disparities in who gets this care. I think we can all agree it is not OK that certain groups of people are less likely to get surgical treatments that can help them live longer."