Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;64(1):127-138.
doi: 10.1111/epi.17452. Epub 2022 Nov 14.

Epilepsy center characteristics and geographic region influence presurgical testing in the United States

Stephanie M Ahrens  1 , Kristen H Arredondo  2 , Anto I Bagić  3 , Shasha Bai  4 , Kevin E Chapman  5 , Michael A Ciliberto  6 , Dave F Clarke  2 , Mariah Eisner  7 , Nathan B Fountain  8 , Jay R Gavvala  9 , M Scott Perry  10 , Kyle C Rossi  11 , Lily C Wong-Kisiel  12 , Susan T Herman  13 , Adam P Ostendorf  1 ; NAEC Center Director Study Group
Affiliations

Epilepsy center characteristics and geographic region influence presurgical testing in the United States

Stephanie M Ahrens et al. Epilepsia. 2023 Jan.

Abstract

Objective: Persons with drug-resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy.

Methods: We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and US Census regional data. We used Wilcoxon rank-sum, Kruskal-Wallis, and chi-squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables.

Results: The response rate was 100% with individual element missingness < 11% across 342 observations undergoing univariate analysis. A total of 278 complete observations were included in the multivariable models, and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR = 2.87, 95% confidence interval [CI] = 1.2-6.86; p = .018) and fluorodeoxyglucose-positron emission tomography (OR = 2.74, 95% CI = = 1.14-6.61; p = .025) more commonly. For centers in the Northeast (OR = .46, 95% CI = .23-.93; p = .031) and West (OR = .41, 95% CI = .19-.87; p = .022), odds of performing single-photon emission computerized tomography were lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume, and resources were also associated with varying individual testing rates.

Significance: Presurgical testing for drug-resistant epilepsy is influenced by US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment.

Keywords: drug-resistant epilepsy (DRE); epilepsy monitoring unit (EMU); epilepsy surgery.

PubMed Disclaimer

Conflict of interest statement

None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

References

    1. Zack MM, Kobau R. National and state estimates of the numbers of adults and children with active epilepsy – United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(31):821–5. - PMC - PubMed
    1. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314–9. - PubMed
    1. Taylor RS, Sander JW, Taylor RJ, Baker GA. Predictors of health‐related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia. 2011;52(12):2168–80. - PubMed
    1. Ostendorf AP, Gedela S. Effect of epilepsy on families, communities, and society. Semin Pediatr Neurol. 2017;24(4):340–7. - PubMed
    1. Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal‐lobe epilepsy. N Engl J Med. 2001;345(5):311–8. - PubMed

Publication types