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Does TBI-Induced Inflammation Contribute to Seizure Development
In a study of 256 patients with moderate-to-severe traumatic brain injury (TBI), researchers showed that higher cerebral spinal fluid and serum interleukin- 1beta (IL-1β) ratios were associated with increased risk of posttraumatic epilepsy (PTE). This is the first report of its type and results provide evidence that biologic variability with blood-brain barrier integrity during recovery from TBI could be attributed to genetic and IL-1β genetic and ratio associations with PTE. Further studies are needed to confirm these findings.
Diamond ML, Ritter AC, Failla MD, et al. IL-1β associations with posttraumatic epilepsy development: A genetics and biomarker cohort study. Epilepsia. 2015;56(7):991-1001.
In a study of 256 patients with moderate-to-severe traumatic brain injury (TBI), researchers showed that higher cerebral spinal fluid and serum interleukin- 1beta (IL-1β) ratios were associated with increased risk of posttraumatic epilepsy (PTE). This is the first report of its type and results provide evidence that biologic variability with blood-brain barrier integrity during recovery from TBI could be attributed to genetic and IL-1β genetic and ratio associations with PTE. Further studies are needed to confirm these findings.
Diamond ML, Ritter AC, Failla MD, et al. IL-1β associations with posttraumatic epilepsy development: A genetics and biomarker cohort study. Epilepsia. 2015;56(7):991-1001.
In a study of 256 patients with moderate-to-severe traumatic brain injury (TBI), researchers showed that higher cerebral spinal fluid and serum interleukin- 1beta (IL-1β) ratios were associated with increased risk of posttraumatic epilepsy (PTE). This is the first report of its type and results provide evidence that biologic variability with blood-brain barrier integrity during recovery from TBI could be attributed to genetic and IL-1β genetic and ratio associations with PTE. Further studies are needed to confirm these findings.
Diamond ML, Ritter AC, Failla MD, et al. IL-1β associations with posttraumatic epilepsy development: A genetics and biomarker cohort study. Epilepsia. 2015;56(7):991-1001.
Can measures help predict neurocognitive outcomes following ATL?
Researchers examined 32 patients with temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL). Patients underwent pre-and postsurgery neuropsychological functional testing. The study found that presurgery resting-state functional connectivity (rsFC) graph-theory measures can help predict neurocognitive outcomes after ATL. The integration measure was the most predictive of neurocognitive outcomes while segregation measure was the least predictive.
Doucet GE, Rider R, Taylor N, et al. Presurgery resting-state local graph-theory measures predict neurocognitive outcomes after brain surgery in temporal lobe epilepsy. Epilepsia. 2015;56(4):517-526.
Researchers examined 32 patients with temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL). Patients underwent pre-and postsurgery neuropsychological functional testing. The study found that presurgery resting-state functional connectivity (rsFC) graph-theory measures can help predict neurocognitive outcomes after ATL. The integration measure was the most predictive of neurocognitive outcomes while segregation measure was the least predictive.
Doucet GE, Rider R, Taylor N, et al. Presurgery resting-state local graph-theory measures predict neurocognitive outcomes after brain surgery in temporal lobe epilepsy. Epilepsia. 2015;56(4):517-526.
Researchers examined 32 patients with temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL). Patients underwent pre-and postsurgery neuropsychological functional testing. The study found that presurgery resting-state functional connectivity (rsFC) graph-theory measures can help predict neurocognitive outcomes after ATL. The integration measure was the most predictive of neurocognitive outcomes while segregation measure was the least predictive.
Doucet GE, Rider R, Taylor N, et al. Presurgery resting-state local graph-theory measures predict neurocognitive outcomes after brain surgery in temporal lobe epilepsy. Epilepsia. 2015;56(4):517-526.
Health Resource Utilization after Video-EEG Confirmation of PNES among US Veterans
Researchers examined health care records of 65 US veterans before and after confirmed diagnosis of psychogenic nonepileptic seizures (PNES) using video-EEG (VEEG) monitoring. Researchers found that post diagnosis there were:
- a significant decrease in PNES-related outpatient visits
- a significant increase in non-PNES related outpatient visits
- increased attendance of psychiatric outpatient visits.
This new evidence shows that VEEG-confirmed PNES diagnosis in US veterans can reduce key measures of non-psychiatric/PNES-related resource utilization and show appropriate increase in psychiatric outpatient visits. However, further study is needed to investigate the increase in non-PNES-related outpatient visits in this patient population.
Nunez-Wallace KR, Murphey DK, Proto D, et al. Health resource utilization among US veterans with psychogenic nonepileptic seizures: a comparison before and after video-EEG monitoring. Epilepsy Res. 2015;114:114-121.
Researchers examined health care records of 65 US veterans before and after confirmed diagnosis of psychogenic nonepileptic seizures (PNES) using video-EEG (VEEG) monitoring. Researchers found that post diagnosis there were:
- a significant decrease in PNES-related outpatient visits
- a significant increase in non-PNES related outpatient visits
- increased attendance of psychiatric outpatient visits.
This new evidence shows that VEEG-confirmed PNES diagnosis in US veterans can reduce key measures of non-psychiatric/PNES-related resource utilization and show appropriate increase in psychiatric outpatient visits. However, further study is needed to investigate the increase in non-PNES-related outpatient visits in this patient population.
Nunez-Wallace KR, Murphey DK, Proto D, et al. Health resource utilization among US veterans with psychogenic nonepileptic seizures: a comparison before and after video-EEG monitoring. Epilepsy Res. 2015;114:114-121.
Researchers examined health care records of 65 US veterans before and after confirmed diagnosis of psychogenic nonepileptic seizures (PNES) using video-EEG (VEEG) monitoring. Researchers found that post diagnosis there were:
- a significant decrease in PNES-related outpatient visits
- a significant increase in non-PNES related outpatient visits
- increased attendance of psychiatric outpatient visits.
This new evidence shows that VEEG-confirmed PNES diagnosis in US veterans can reduce key measures of non-psychiatric/PNES-related resource utilization and show appropriate increase in psychiatric outpatient visits. However, further study is needed to investigate the increase in non-PNES-related outpatient visits in this patient population.
Nunez-Wallace KR, Murphey DK, Proto D, et al. Health resource utilization among US veterans with psychogenic nonepileptic seizures: a comparison before and after video-EEG monitoring. Epilepsy Res. 2015;114:114-121.
What are the Predictors of Cognitive Side Effects among AED Use?
A retrospective study examined medical records of 2860 adult patients with epilepsy over a 12-year period. Researchers found that in patients with new medication:
- 11.2% of those on polytherapy had intolerable cognitive side effects (CSEs)
- 7.6% of those on monotherapy had intolerable CSEs
Polytherapy and intellectual disability were found to be predictors of cognitive side effects. Intolerable CSEs were most commonly seen with topiramate in both polytherapy and monotherapy.
Javed A, Cohen B, Detyniecki K, et al. Rates and predictors of patient-reported cognitive side effects of antiepileptic drugs: an extended follow-up. Seizure. 2015;29:34-40.
A retrospective study examined medical records of 2860 adult patients with epilepsy over a 12-year period. Researchers found that in patients with new medication:
- 11.2% of those on polytherapy had intolerable cognitive side effects (CSEs)
- 7.6% of those on monotherapy had intolerable CSEs
Polytherapy and intellectual disability were found to be predictors of cognitive side effects. Intolerable CSEs were most commonly seen with topiramate in both polytherapy and monotherapy.
Javed A, Cohen B, Detyniecki K, et al. Rates and predictors of patient-reported cognitive side effects of antiepileptic drugs: an extended follow-up. Seizure. 2015;29:34-40.
A retrospective study examined medical records of 2860 adult patients with epilepsy over a 12-year period. Researchers found that in patients with new medication:
- 11.2% of those on polytherapy had intolerable cognitive side effects (CSEs)
- 7.6% of those on monotherapy had intolerable CSEs
Polytherapy and intellectual disability were found to be predictors of cognitive side effects. Intolerable CSEs were most commonly seen with topiramate in both polytherapy and monotherapy.
Javed A, Cohen B, Detyniecki K, et al. Rates and predictors of patient-reported cognitive side effects of antiepileptic drugs: an extended follow-up. Seizure. 2015;29:34-40.
Continuous Electroencephalography (cEEG) Provides Independent Outcome Information
In a study of 120 adult patients with status epilepticus (SE), researchers found that cEEG background information (posterior dominant rhythm and sleep patterns) to be more predictive of clinical outcome than seizures or rhythmic and periodic patterns. Of the EEG features studied, only two were significantly correlated with outcome: absence of a posterior dominant rhythm for mortality and changes in stage II sleep patterns for complete recovery.
Alvarez V, Drislane FW, Westover MB, Dworetzky BA, Lee JW. Characteristics and role in outcome prediction of continuous EEG after status epilepticus: a prospective observational cohort study. Epilepsia. 2015;56(6):933-941.
In a study of 120 adult patients with status epilepticus (SE), researchers found that cEEG background information (posterior dominant rhythm and sleep patterns) to be more predictive of clinical outcome than seizures or rhythmic and periodic patterns. Of the EEG features studied, only two were significantly correlated with outcome: absence of a posterior dominant rhythm for mortality and changes in stage II sleep patterns for complete recovery.
Alvarez V, Drislane FW, Westover MB, Dworetzky BA, Lee JW. Characteristics and role in outcome prediction of continuous EEG after status epilepticus: a prospective observational cohort study. Epilepsia. 2015;56(6):933-941.
In a study of 120 adult patients with status epilepticus (SE), researchers found that cEEG background information (posterior dominant rhythm and sleep patterns) to be more predictive of clinical outcome than seizures or rhythmic and periodic patterns. Of the EEG features studied, only two were significantly correlated with outcome: absence of a posterior dominant rhythm for mortality and changes in stage II sleep patterns for complete recovery.
Alvarez V, Drislane FW, Westover MB, Dworetzky BA, Lee JW. Characteristics and role in outcome prediction of continuous EEG after status epilepticus: a prospective observational cohort study. Epilepsia. 2015;56(6):933-941.
New Recommendations for Neuropsychological Assessment in Epilepsy
The International League Against Epilepsy (ILAE) Neuropsychology Task force developed recommendations to address the neuropsychological assessment in routine epilepsy care. The recommendations endorse:
- Routine screening of cognition, mood, and behavior in new-onset epilepsy patients
- Routine feedback to patients, families, and clinicians about assessment results and implications.
The ILAE recommendations also identify situations where detailed, formal neuropsychological assessment is warranted.
Wilson SJ, Baxendale S, Barr W, et al. Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017. Epilepsia. 2015;56(5):674-681.
The International League Against Epilepsy (ILAE) Neuropsychology Task force developed recommendations to address the neuropsychological assessment in routine epilepsy care. The recommendations endorse:
- Routine screening of cognition, mood, and behavior in new-onset epilepsy patients
- Routine feedback to patients, families, and clinicians about assessment results and implications.
The ILAE recommendations also identify situations where detailed, formal neuropsychological assessment is warranted.
Wilson SJ, Baxendale S, Barr W, et al. Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017. Epilepsia. 2015;56(5):674-681.
The International League Against Epilepsy (ILAE) Neuropsychology Task force developed recommendations to address the neuropsychological assessment in routine epilepsy care. The recommendations endorse:
- Routine screening of cognition, mood, and behavior in new-onset epilepsy patients
- Routine feedback to patients, families, and clinicians about assessment results and implications.
The ILAE recommendations also identify situations where detailed, formal neuropsychological assessment is warranted.
Wilson SJ, Baxendale S, Barr W, et al. Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017. Epilepsia. 2015;56(5):674-681.
AAN Revises Epilepsy Update Quality Measurement Set
The American Academy of Neurology’s Epilepsy Update Quality Measurement Set workgroup retired 3 of the 2009 recommendations; revised 5 recommendations; and added 2 more. The new quality measurement set includes:
At each encounter:
o Specify etiology, seizure type, and epilepsy syndrome
o Ask about side effects of antiepileptic therapy and offer intervention
Once a year:
o Counsel women of childbearing potential with epilepsy
Every 2 years:
Fountain NB, Van Ness PC, Bennett A, et al. Quality improvement in neurology: epilepsy update quality measurement set. Neurology. 2015;84(14):1483-1487.
The American Academy of Neurology’s Epilepsy Update Quality Measurement Set workgroup retired 3 of the 2009 recommendations; revised 5 recommendations; and added 2 more. The new quality measurement set includes:
At each encounter:
o Specify etiology, seizure type, and epilepsy syndrome
o Ask about side effects of antiepileptic therapy and offer intervention
Once a year:
o Counsel women of childbearing potential with epilepsy
Every 2 years:
Fountain NB, Van Ness PC, Bennett A, et al. Quality improvement in neurology: epilepsy update quality measurement set. Neurology. 2015;84(14):1483-1487.
The American Academy of Neurology’s Epilepsy Update Quality Measurement Set workgroup retired 3 of the 2009 recommendations; revised 5 recommendations; and added 2 more. The new quality measurement set includes:
At each encounter:
o Specify etiology, seizure type, and epilepsy syndrome
o Ask about side effects of antiepileptic therapy and offer intervention
Once a year:
o Counsel women of childbearing potential with epilepsy
Every 2 years:
Fountain NB, Van Ness PC, Bennett A, et al. Quality improvement in neurology: epilepsy update quality measurement set. Neurology. 2015;84(14):1483-1487.
Are Status Epilepticus Hospitalizations Increasing?
Over 400,000 status epilepticus-related hospital visits between January 1, 1999 and December 31, 2010 were examined in 2 retrospective serial cross-sectional studies. Status epilepticus-related mortality was relatively stable over the 12-year range but there was a marked increase in status epilepticus hospitalizations (increase of 56.4% from 1999 to 2010). The authors suggest this change could be due to an increase in status epilepticus diagnoses through advanced diagnostic sensitivity or adjustments in medical billing and coding. The authors advocate that the standard approach to status epilepticus should evolve with these new epidemiologic trends.
Betjemann JP, Josephson SA, Lowenstein DH, Burke JF. Trends in status epilepticus-related hospitalizations and mortality: redefined in US practice over time [published online ahead of print April 27, 2015]. JAMA Neurol. 2015:doi:10.1001/jamaneurol.2015.0188.
Over 400,000 status epilepticus-related hospital visits between January 1, 1999 and December 31, 2010 were examined in 2 retrospective serial cross-sectional studies. Status epilepticus-related mortality was relatively stable over the 12-year range but there was a marked increase in status epilepticus hospitalizations (increase of 56.4% from 1999 to 2010). The authors suggest this change could be due to an increase in status epilepticus diagnoses through advanced diagnostic sensitivity or adjustments in medical billing and coding. The authors advocate that the standard approach to status epilepticus should evolve with these new epidemiologic trends.
Betjemann JP, Josephson SA, Lowenstein DH, Burke JF. Trends in status epilepticus-related hospitalizations and mortality: redefined in US practice over time [published online ahead of print April 27, 2015]. JAMA Neurol. 2015:doi:10.1001/jamaneurol.2015.0188.
Over 400,000 status epilepticus-related hospital visits between January 1, 1999 and December 31, 2010 were examined in 2 retrospective serial cross-sectional studies. Status epilepticus-related mortality was relatively stable over the 12-year range but there was a marked increase in status epilepticus hospitalizations (increase of 56.4% from 1999 to 2010). The authors suggest this change could be due to an increase in status epilepticus diagnoses through advanced diagnostic sensitivity or adjustments in medical billing and coding. The authors advocate that the standard approach to status epilepticus should evolve with these new epidemiologic trends.
Betjemann JP, Josephson SA, Lowenstein DH, Burke JF. Trends in status epilepticus-related hospitalizations and mortality: redefined in US practice over time [published online ahead of print April 27, 2015]. JAMA Neurol. 2015:doi:10.1001/jamaneurol.2015.0188.
Is MEG a Valuable Tool for Interictal Spike Mapping before Epilepsy Surgery?
A retrospective cohort study of 132 patients with focal epilepsy who received MEG and underwent resective surgery found that magnetoencephalography (MEG) was a valuable tool for noninvasive interictal spike mapping. Prior to the results of this study, the clinical utility of MEG in presurgical evaluation of patients with epilepsy was not fully understood because of the lack of long-term outcomes or small sample sizes. The reliability of MEG was comparable in patients with or without localized scalp EEG and the use of MEG to localize the epileptogenic zone was associated with improved seizure outcomes.
Englot DJ, Nagarajan SS, Imber BS, et al. Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery [published online ahead of print April 29, 2015]. Epilepsia. 2015:doi:10.1111/epi.13002.
A retrospective cohort study of 132 patients with focal epilepsy who received MEG and underwent resective surgery found that magnetoencephalography (MEG) was a valuable tool for noninvasive interictal spike mapping. Prior to the results of this study, the clinical utility of MEG in presurgical evaluation of patients with epilepsy was not fully understood because of the lack of long-term outcomes or small sample sizes. The reliability of MEG was comparable in patients with or without localized scalp EEG and the use of MEG to localize the epileptogenic zone was associated with improved seizure outcomes.
Englot DJ, Nagarajan SS, Imber BS, et al. Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery [published online ahead of print April 29, 2015]. Epilepsia. 2015:doi:10.1111/epi.13002.
A retrospective cohort study of 132 patients with focal epilepsy who received MEG and underwent resective surgery found that magnetoencephalography (MEG) was a valuable tool for noninvasive interictal spike mapping. Prior to the results of this study, the clinical utility of MEG in presurgical evaluation of patients with epilepsy was not fully understood because of the lack of long-term outcomes or small sample sizes. The reliability of MEG was comparable in patients with or without localized scalp EEG and the use of MEG to localize the epileptogenic zone was associated with improved seizure outcomes.
Englot DJ, Nagarajan SS, Imber BS, et al. Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery [published online ahead of print April 29, 2015]. Epilepsia. 2015:doi:10.1111/epi.13002.
Pediatric Epilepsy Surgeries Have Increased in the Past Decade
The rate of pediatric epilepsy surgery has increased significantly in the United States during the past decade, according to an investigation published in the March issue of Epilepsia. Nevertheless, epilepsy surgery remains an underutilized treatment in children with epilepsy, according to the researchers.
“Continued emphasis on highlighting awareness of epilepsy surgery among pediatricians and pediatric neurologists is as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care,” said Elia M. Pestana Knight, MD, a neurologist at the Cleveland Clinic Epilepsy Center.
An Analysis of a Pediatric Database
Research indicates that the rate of epilepsy surgery in adults has either declined or remained stable in the past decade. Dr. Pestana Knight and colleagues, however, hypothesized that rates of epilepsy surgery in the pediatric population had increased over time. To test this hypothesis, the investigators performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database (KID) from 1997 to 2009. They calculated the rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year based on the number of prevalent epilepsy cases in the corresponding year. The researchers also estimated age-, race-, and sex-adjusted rates of surgeries.
Dr. Pestana Knight’s group used the Mann-Kendall trend test to identify changes in the rates of surgeries over time. Multivariable regression analysis enabled the group to estimate the effects of time, age, race, and sex on the annual incidence of epilepsy surgery.
Surgeries Increased in All Patient Subgroups
The number of epilepsy surgeries increased steadily from 375 in 1997 to 706 in 2009. The increase in surgeries occurred in all age groups except infants. Whites had the greatest number of surgeries, compared with blacks, Hispanics, and other minorities. Children with private insurance also had the highest number of surgeries performed, compared with children in public insurance programs and children with “other” payers (a category that included the uninsured).
The number of surgeries for each study year was less than 35% of children who are expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. After the investigators adjusted for age, race, sex, and changes in population distribution during the study period, the rates of pediatric epilepsy surgeries increased significantly from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009.
Although the rate of surgery increased in all patient subgroups, the increase was lowest among black children (compared with other races) and among children with public insurance (compared with children with private insurance). Age, race, and sex were independent predictors of surgery. Findings related to race should be interpreted with caution, said the researchers, because some hospitals and states do not provide data on race to the Healthcare Cost and Utilization Project, which encompasses KID.
“This is the first study that provides national estimates of pediatric epilepsy surgery utilization in the United States,” said Dr. Pestana Knight. “An increasing trend of surgical rates in publicly insured children with epilepsy is a hopeful finding that access to specialized epilepsy care in low-income children or patients’ and physicians’ perception and understanding of surgical treatment have improved. … Our findings emphasize that improving access to specialized epilepsy care for all children with epilepsy is as important as ever.”
—Erik Greb
Suggested Reading
Pestana Knight EM, Schiltz NK, Bakaki PM, et al. Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009. Epilepsia. 2015;56(3):375-381.
The rate of pediatric epilepsy surgery has increased significantly in the United States during the past decade, according to an investigation published in the March issue of Epilepsia. Nevertheless, epilepsy surgery remains an underutilized treatment in children with epilepsy, according to the researchers.
“Continued emphasis on highlighting awareness of epilepsy surgery among pediatricians and pediatric neurologists is as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care,” said Elia M. Pestana Knight, MD, a neurologist at the Cleveland Clinic Epilepsy Center.
An Analysis of a Pediatric Database
Research indicates that the rate of epilepsy surgery in adults has either declined or remained stable in the past decade. Dr. Pestana Knight and colleagues, however, hypothesized that rates of epilepsy surgery in the pediatric population had increased over time. To test this hypothesis, the investigators performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database (KID) from 1997 to 2009. They calculated the rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year based on the number of prevalent epilepsy cases in the corresponding year. The researchers also estimated age-, race-, and sex-adjusted rates of surgeries.
Dr. Pestana Knight’s group used the Mann-Kendall trend test to identify changes in the rates of surgeries over time. Multivariable regression analysis enabled the group to estimate the effects of time, age, race, and sex on the annual incidence of epilepsy surgery.
Surgeries Increased in All Patient Subgroups
The number of epilepsy surgeries increased steadily from 375 in 1997 to 706 in 2009. The increase in surgeries occurred in all age groups except infants. Whites had the greatest number of surgeries, compared with blacks, Hispanics, and other minorities. Children with private insurance also had the highest number of surgeries performed, compared with children in public insurance programs and children with “other” payers (a category that included the uninsured).
The number of surgeries for each study year was less than 35% of children who are expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. After the investigators adjusted for age, race, sex, and changes in population distribution during the study period, the rates of pediatric epilepsy surgeries increased significantly from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009.
Although the rate of surgery increased in all patient subgroups, the increase was lowest among black children (compared with other races) and among children with public insurance (compared with children with private insurance). Age, race, and sex were independent predictors of surgery. Findings related to race should be interpreted with caution, said the researchers, because some hospitals and states do not provide data on race to the Healthcare Cost and Utilization Project, which encompasses KID.
“This is the first study that provides national estimates of pediatric epilepsy surgery utilization in the United States,” said Dr. Pestana Knight. “An increasing trend of surgical rates in publicly insured children with epilepsy is a hopeful finding that access to specialized epilepsy care in low-income children or patients’ and physicians’ perception and understanding of surgical treatment have improved. … Our findings emphasize that improving access to specialized epilepsy care for all children with epilepsy is as important as ever.”
—Erik Greb
The rate of pediatric epilepsy surgery has increased significantly in the United States during the past decade, according to an investigation published in the March issue of Epilepsia. Nevertheless, epilepsy surgery remains an underutilized treatment in children with epilepsy, according to the researchers.
“Continued emphasis on highlighting awareness of epilepsy surgery among pediatricians and pediatric neurologists is as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care,” said Elia M. Pestana Knight, MD, a neurologist at the Cleveland Clinic Epilepsy Center.
An Analysis of a Pediatric Database
Research indicates that the rate of epilepsy surgery in adults has either declined or remained stable in the past decade. Dr. Pestana Knight and colleagues, however, hypothesized that rates of epilepsy surgery in the pediatric population had increased over time. To test this hypothesis, the investigators performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database (KID) from 1997 to 2009. They calculated the rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year based on the number of prevalent epilepsy cases in the corresponding year. The researchers also estimated age-, race-, and sex-adjusted rates of surgeries.
Dr. Pestana Knight’s group used the Mann-Kendall trend test to identify changes in the rates of surgeries over time. Multivariable regression analysis enabled the group to estimate the effects of time, age, race, and sex on the annual incidence of epilepsy surgery.
Surgeries Increased in All Patient Subgroups
The number of epilepsy surgeries increased steadily from 375 in 1997 to 706 in 2009. The increase in surgeries occurred in all age groups except infants. Whites had the greatest number of surgeries, compared with blacks, Hispanics, and other minorities. Children with private insurance also had the highest number of surgeries performed, compared with children in public insurance programs and children with “other” payers (a category that included the uninsured).
The number of surgeries for each study year was less than 35% of children who are expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. After the investigators adjusted for age, race, sex, and changes in population distribution during the study period, the rates of pediatric epilepsy surgeries increased significantly from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009.
Although the rate of surgery increased in all patient subgroups, the increase was lowest among black children (compared with other races) and among children with public insurance (compared with children with private insurance). Age, race, and sex were independent predictors of surgery. Findings related to race should be interpreted with caution, said the researchers, because some hospitals and states do not provide data on race to the Healthcare Cost and Utilization Project, which encompasses KID.
“This is the first study that provides national estimates of pediatric epilepsy surgery utilization in the United States,” said Dr. Pestana Knight. “An increasing trend of surgical rates in publicly insured children with epilepsy is a hopeful finding that access to specialized epilepsy care in low-income children or patients’ and physicians’ perception and understanding of surgical treatment have improved. … Our findings emphasize that improving access to specialized epilepsy care for all children with epilepsy is as important as ever.”
—Erik Greb
Suggested Reading
Pestana Knight EM, Schiltz NK, Bakaki PM, et al. Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009. Epilepsia. 2015;56(3):375-381.
Suggested Reading
Pestana Knight EM, Schiltz NK, Bakaki PM, et al. Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009. Epilepsia. 2015;56(3):375-381.