A comparison of waiting times for assessment and epilepsy surgery between a Canadian and a Mexican referral center

Abstract

SummaryObjectiveTo provide a comprehensive transnational overview of wait times for epilepsy surgery in Canada and Mexico.MethodsWe reviewed all cases referred for epilepsy surgery between 2007 and 2015 at the Saskatchewan Epilepsy Program Royal University Hospital (SEP) (n = 70; Saskatoon, Canada) and the National Institute of Neurology and Neurosurgery (NINN) (n = 76; Mexico City, Mexico) and compared wait times, calculated as the time from diagnosis of epilepsy on assessment at an epilepsy center to epilepsy surgery.ResultsMean wait times were similar across centers. Mean patient age was 37.4 ± 9 years (NINN) and 36.7 ± 13.2 years (SEP). The mean time from epilepsy diagnosis to referral was 18.9 (NINN) and 16.9 years (SEP), p = 0.30; first consult with the epileptologist, 19.7 (NINN) and 17.4 years (p = 0.23); neuropsychology consult, 21.4 (NINN) and 17.9 years (SEP); video electroencephalogram (video‐EEG) telemetry, 21.1 (NINN) and 18.6 months (SEP); initial neurosurgical consult, 21.9 (NINN) and 19.1 years (SEP) (p = 0.35); and epilepsy surgery, 19.7 (NINN) and 19.6 years (SEP) (p = 0.29).SignificanceThis is the first study to compare wait times between Canada and Mexico. Despite disparity in their health delivery systems and financial resources, surgical wait times appeared to be protracted in both nations, confirming that delayed treatment is a universal problem that requires collaborative scrutiny.

Promoting faster pathways to surgery: a clinical audit of patients with refractory epilepsy

“…The mean waiting time from the first visit to surgical referral for the patients in our study was 38.8 (SD 16.9) weeks, with an additional 17.2 weeks between referral to the surgical team and the first post-operative visit. This compares favorably to a 2017 Canadian and Mexican comparative study which showed the average waiting times from the first epilepsy center visit to surgery of 111.4 weeks ( n = 72) in Canada, and 182.8 weeks ( n = 81) in Mexico, versus 55.8 weeks in our study [31].…”

“…The results for the age at presentation to the clinic and years living with epilepsy were similar to the Canadian and Mexican study: patient age was 36.7 and 37.4 in Canada and Mexico, respectively, versus 36.9 in our study; and years with epilepsy were 20.2 and 27.4 in Canada and Mexico respectively, versus 18.5 years in our study. The literature indicates that delays in surgical treatment are mainly due to delays in referral to specialist clinics, rather than delays in assessment and the decision to proceed to surgery once under the care of the clinic [30, 31].…”

Leading up to saying "yes": A qualitative study on the experience of patients with refractory epilepsy regarding presurgical investigation for resective surgery

“…However, there remains a concern that patients who may benefit from the procedure are not being referred for surgery eligibility assessment in a timely manner or those who, despite being assessed as suitable surgical candidates, elect to not undergo the procedure [9][10][11][12]. Globally, studies suggest that eligible patients can live for up to 20 years or more before they receive surgical treatment [13][14][15][16].…”

Epilepsy: A Call for Help

“…The wait times to see a neurosurgeon are often large. In most countries, the time from diagnosis to referral to an epilepsy center ranges from 18.9 [ 1 ] to 20 years [ 2 ].…”

“…A patient with GBM reaches the surgeon usually within a few days after diagnosis. A patient with epilepsy takes 18–20 years [ 1 , 2 ] from diagnosis to reach the surgeon in most countries. This is a problem.…”