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SUMMARYPurpose: The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care. Methods: Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage.Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care. Results: Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model. Discussion: There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care. KEY WORDS: Epilepsy, Health care utilization, Disparities, Sociodemographics, Race/ethnicity.A number of studies provide evidence that minorities with epilepsy in the United States receive different amounts of health care compared to nonminority whites (see literature reviews by Szaflarski et al., 2006 and Theodore et al., 2006). This is a concern for advocates and policy makers who seek to eliminate inequalities in epilepsy care and improve the health of high-risk populations. However, there are no studies examining the extent to which the disparities can be explained by such factors as differences in individual patient characteristics or variations in provider practices. We are conducting a 1-year longitudinal study of epilepsy care at four sites, two in Houston and two in Answers to such questions are needed to help inform program administrators, providers, and policy makers of the underlying reasons for disparities so that effective strategies might be designed to reduce or eliminate them.This report describes the methods used to conduct the study and provides preliminary results based on initial baseline data from the patient sample.

Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is usually refractory to medical management. When medications fail, alternative therapies are considered. Among these are two surgical options: corpus callosotomy and vagus nerve stimulation (VNS). Safety and efficacy are two important factors to consider when selecting an appropriate treatment. VNS is safer than callosotomy, but its efficacy is more difficult to assess. Available studies evaluate its effectiveness using a mixed population of patients (some with prior epilepsy surgery), a multitude of VNS settings, and variable endpoints. To estimate the efficacy of VNS in patients with LGS, a review of the medical literature and the VNS Patient Registry was performed. Within the limits of this type of study, the results showed that VNS appears equally as effective as callosotomy. Because VNS has a lower potential for adverse events, these results suggest that VNS should be considered first in appropriately selected patient.

Acute symptomatic seizures occur most often in illnesses that directly injure the brain. Trauma, stroke, CNS tumors, and CNS infection very commonly cause seizures. However, many medical illnesses do not directly injure the brain but lead to neurologic signs and symptoms, such as seizures. Recognizing these effects, especially in critically ill patients, is important for optimizing medical care.

In their article, "Neuropsychological and Neurophysiologic Effects of Carbamazepine and Levetiracetam," Dr. Meador and his colleagues describe the results of a detailed study designed to look at how antiseizure medications affect a person's thinking. 1 They looked at two medications, carbamazepine (the trade name is Tegretol or Carbatrol) and levetiracetam (the trade name is Keppra). The reason for the study was simple: to determine which medicine causes fewer problems with memory, attention, clarity of thinking, and speed of thinking. Dr. Meador asked 28 people to volunteer to take both medications. These were healthy people. In other words, they did not have neurologic or psychological problems that might cause problems with thinking. The volunteers could not be using drugs or prescribed medications that could affect the brain. Because alcohol can cause trouble with thinking clearly or quickly, the volunteers could not drink any kind of alcohol for 3 days before testing. Each person had memory and cognitive testing (the neuropsychological testing) six times. There were two tests before the person had taken any medication. When they had been on one medicine for 8 weeks, the testing was repeated to see how the person's scores changed when they were on medication vs off. The medication was then stopped and allowed to "wash out" of the system. During the 4-week "washout," memory testing was repeated. After this, the volunteer started the second medication. Again, at the end of 8 weeks of taking the medication, the memory testing was done. The medicine was again allowed to wash out, at which point the testing was done for the final time. During the study, the medication tablets were all made to look the same. This way, the volunteers did not know which medication they were taking. The same was true for the doctors who were doing the memory testing: they did not know which medication the person was taking at that time. This kind of study is called "double-blind." It means that neither the doctors nor the volunteers knew which medicine they were taking. The reason to do studies in this

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