Addressing the epilepsy surgery gap: Impact of community/tertiary epilepsy center collaboration

Peterson, Keyan; LaRoche, Suzette M.; Cummings, Tiffany; Woodard, Valerie; Moise, Anna-Marieta; Clary, Heidi M. Munger

doi:10.1016/j.ebr.2020.100398

Cited by 7 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the evidence and new clinical practice guidelines recommending earlier referrals for epilepsy surgery, significant barriers remain resulting in delayed referral patterns and increased hospitalizations for epilepsy without a similar trend in the number of epilepsy surgeries performed. [ 8 , 17 , 21 ] In our study of the NIS from 2012 to 2014, we found many statistically significant barriers that limit access to epilepsy surgery. The three most significant barriers were race (Black), income (<$40,000), and location (rural).…”

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

“…It is essential that primary care providers and neurologists be educated on the efficacy of epilepsy surgery and early referral to epilepsy centers is encouraged. [ 6 , 15 , 17 ] Neurosurgeons who perform epilepsy procedures and epilepsy foundations can provide such education in this regard. The Connectors Project is a strong example of how educational outreach to providers and patients and their families can improve access to information and emerging trends in rural and underserved communities by connecting patients and providers.…”

Section: Discussionmentioning

confidence: 99%

“…[31] Forming collaborative relationships between community and tertiary centers are a proven method to increase the number of referrals for epilepsy surgery and patients whose cases are discussed in a multidisciplinary epilepsy conference. [17,22] Potential solutions e above factors each play a unique role that affects access to epilepsy surgery. It is essential that primary care providers and neurologists be educated on the efficacy of epilepsy surgery and early referral to epilepsy centers is encouraged.…”

Section: Geographic Barriers To Epilepsy Surgerymentioning

confidence: 99%

See 3 more Smart Citations

Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

Bernstein

Kashyap

Kortz

et al. 2021

Surgical Neurology International

View full text Add to dashboard Cite

Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases. Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure. Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure. Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Geographic Barriers To Epilepsy Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

Bernstein

Kashyap

Kortz

et al. 2021

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Partnerships with regional epilepsy centers are an appropriate means to improve local access to surgical care through specialized centers [119], and appropriate training of rural physicians or medical personnel is essential to identify referral candidates. For this reason, integration of all levels of epilepsy care is needed to close the surgical treatment gap in the long term [120]. It is noteworthy that even if epilepsy surgery already exists in an LMIC, surgical centers are most likely located in the major cities [9] and are not sufficient to cover all the needs [10,116,121,122].…”

Section: Use a Multi-tiered System To Reach Areas Outside The Large C...mentioning

confidence: 99%

Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries

Bäuerle¹,

Schneider²,

Holtkamp³

et al. 2022

J. Integr. Neurosci.

View full text Add to dashboard Cite

Surgery is an essential treatment option for patients with drug-resistant epilepsy. While most epilepsy patients worldwide live in low-and middle-income countries (LMIC), most of these countries do not have epilepsy surgery, and those that do have surgical epilepsy services lack capacities. The rapidly growing population in LMIC further widens the gap between the number of patients who can potentially benefit from surgery and those who can actually receive it. This makes the initiation of new surgical epilepsy centers in those countries an urgent issue. Epilepsy surgery is feasible in LMIC, even in resource-poor settings, but lack of local expertise is a major obstacle to the introduction of new surgical services. Importantly, expertise deficits can be compensated by collaborating with a well-established epilepsy center for knowledge transfer, skill building and mentoring. Such projects need to be organized in a multidisciplinary team, should focus on the given circumstances, and should use technologies and personnel that are reasonably available and can function sustainably. Local cultural factors and improvement of patients' quality of life are further spotlights reflected by an increasing number of studies. As a general outline for a new surgical epilepsy program in LMIC, it is recommended to initially focus on patients with mesial temporal lobe epilepsy due to hippocampal sclerosis or other well defined pathologies. These constellations have an excellent surgical outcome in terms of seizure control, can be diagnosed by non-invasive methods, and can be reliably identified even under low-resource conditions. Moreover, surgery can be performed with a highly standardized approach and at reasonable costs, and the vast majority of patients will benefit from surgical intervention. The range of services can then be gradually expanded, depending on growing expertise, local needs, prospects and constraints. Although the introduction of surgical epilepsy services in LMIC can face several challenges, none of them should be a permanent barrier for further establishments.

show abstract