1308. Identifying Factors in the Underutilization of Surgery for Patients with Drug-Resistant Epilepsy (DRE)

Authors: Elena M. Solli, MD; Elena Solli, MD; Irene Say, MD; Rebecca Houston; Luke Tomycz; Jayoung Pak (Newark, NJ)

Introduction: While various surgical procedures have been shown to be safe and effective in treating DRE, epilepsy surgery is currently heavily underutilized throughout the world. The goal of this study is to investigate factors that contribute to the underutilization of epilepsy surgery. In addition, we provide an assessment of referral patterns from our own pediatric epilepsy clinic. Methods: We reviewed charts of the last 100 consecutive patients seen in our epilepsy clinic, and analyzed rates of epilepsy surgery and completion of workup. Subsequently, we conducted a literature search in the electronic database PubMed. Search terms included “epilepsy surgery,” combined with keywords relating to underutilization. Results: Of the last 100 patients seen in our epilepsy clinic, 59 were found to have DRE. Of those with DRE, surgery and/or VNS was discussed with 88.1%. Of these 59, while 59.3% (35/59) underwent VNS, a mere 6.8% (4/59) of patients underwent craniotomy for resection of epileptogenic focus. While many had undergone MRI and EEG, few had undergone other elements of the workup, with 13.6% having completed or having been scheduled for PET scan, 8.5% for SPECT, an 10.7% for MEG. Conclusion: There continue to be a myriad of factors that account for the underutilization of epilepsy surgery, including a lack of formal education of physicians in determining surgical candidacy, the complex nature of the preoperative workup, and the various socioeconomic issues that impede patient access to care. In reviewing data from our pediatric epilepsy clinic, many patients have never undergone all elements of the presurgical workup. We conclude that neurosurgeons should lead the presurgical work-up, and collaborate with our neurology colleagues to identify candidates for surgical resection. In addition, referral for VNS should be seen as an opportunity to interface with a patient population that may qualify for definitive surgical options.