Sociodemographic changes over 25 years of pediatric epilepsy surgery at UCLA

Object Low income, government insurance, and minority status are associated with delayed treatment for neurosurgery patients. Less is known about the influence of referral location and how socioeconomic factors and referral patterns evolve over time. For pediatric epilepsy surgery patients at the University of California, Los Angeles (UCLA), this study determined how referral location and sociodemographic features have evolved over 25 years. Methods Children undergoing epilepsy neurosurgery at UCLA (453 patients) were classified by location of residence and compared with clinical epilepsy and sociodemographic factors. Results From 1986 to 2010, referrals from Southern California increased (+33%) and referrals from outside of California decreased (−19%). Over the same period, the number of patients with preferred provider organization (PPO) and health maintenance organization (HMO) insurance increased (+148% and +69%, respectively) and indemnity insurance decreased (−96%). Likewise, the number of Hispanics (+117%) and Asians (100%) increased and Caucasians/whites decreased (−24%). The number of insurance companies decreased from 52 carriers per 100 surgical patients in 1986–1990 to 19 per 100 in 2006–2010. Patients living in the Eastern US had a younger age at surgery (−46%), shorter intervals from seizure onset to referral for evaluation (−28%) and from presurgical evaluation to surgery (−61%) compared with patients from Southern California. The interval from seizure onset to evaluation was shorter (−33%) for patients from Los Angeles County compared with those living in non-California Western US states. Conclusions Referral locations evolved over 25 years at UCLA, with more cases coming from local regions; the percentage of minority patients also increased. The interval from seizures onset to surgery was shortest for patients living farthest from UCLA but still within the US. Geographic location and race/ethnicity was not associated with differences in becoming seizure free after epilepsy surgery in children.

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Time to Pediatric Epilepsy Surgery Is Longer and Developmental Outcomes Lower for Government Compared With Private Insurance

Neurosurgery ◽

10.1227/01.neu.0000429849.99330.6e ◽

2013 ◽

Vol 73 (1) ◽

pp. 152-157 ◽

Cited By ~ 13

Author(s):

Jason S. Hauptman ◽

Andrew Dadour ◽

Taemin Oh ◽

Christine B. Baca ◽

Barbara G. Vickrey ◽

...

Keyword(s):

State Government ◽

Epilepsy Surgery ◽

Pediatric Patients ◽

Private Insurance ◽

Developmental Outcomes ◽

Rank Test ◽

Pediatric Epilepsy ◽

Seizure Onset ◽

Health Maintenance ◽

Uninsured Children

Abstract BACKGROUND: It is unclear if socioeconomic factors like type of insurance influence time to referral and developmental outcomes for pediatric patients undergoing epilepsy surgery. OBJECTIVE: This study determined whether private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric patients undergoing epilepsy surgery. METHODS: A consecutive cohort (n = 420) of pediatric patients undergoing epilepsy surgery were retrospectively categorized into those with Medicaid (California Children's Services; n = 91) or private (Preferred Provider Organization, Health Maintenance Organization, Indemnity; n = 329) insurance. Intervals from seizure onset to referral and surgery and Vineland developmental assessments were compared by insurance type with the use of log-rank tests. RESULTS: Compared with private insurance, children with Medicaid had longer intervals from seizure onset to referral for evaluation (log-rank test, P = .034), and from seizure onset to surgery (P = .017). In a subset (25%) that had Vineland assessments, children with Medicaid compared with private insurance had lower Vineland scores presurgery (P = .042) and postsurgery (P = .003). Type of insurance was not associated with seizure severity, types of operations, etiology, postsurgical seizure-free outcomes, and complication rate. CONCLUSION: Compared with Medicaid, children with private insurance had shorter intervals from seizure onset to referral and to epilepsy surgery, and this was associated with lower Vineland scores before surgery. These findings may reflect delayed access for uninsured children who eventually obtained state insurance. Reasons for the delay and whether longer intervals before epilepsy surgery affect long-term cognitive and developmental outcomes warrant further prospective investigations.

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Prediction of Seizure-onset Laterality by Using Wada Memory Asymmetries in Pediatric Epilepsy Surgery Candidates

Epilepsia ◽

10.1046/j.1528-1157.2002.48301.x ◽

2002 ◽

Vol 43 (9) ◽

pp. 1049-1055 ◽

Cited By ~ 11

Author(s):

Gregory P. Lee ◽

Yong D. Park ◽

Ann Hempel ◽

Michael Westerveld ◽

David W. Loring

Keyword(s):

Epilepsy Surgery ◽

Pediatric Epilepsy ◽

Seizure Onset ◽

Pediatric Epilepsy Surgery

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Resting-state functional MRI connectivity impact on epilepsy surgery plan and surgical candidacy: prospective clinical work

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.1.peds19695 ◽

2020 ◽

Vol 25 (6) ◽

pp. 574-581 ◽

Cited By ~ 1

Author(s):

Varina L. Boerwinkle ◽

Lucia Mirea ◽

William D. Gaillard ◽

Bethany L. Sussman ◽

Diana Larocque ◽

...

Keyword(s):

Functional Mri ◽

Epilepsy Surgery ◽

Resting State ◽

Intractable Epilepsy ◽

Pediatric Epilepsy ◽

Seizure Onset ◽

Surgery Planning ◽

Seizure Onset Zone ◽

Pediatric Epilepsy Surgery ◽

The Impact

OBJECTIVEThe authors’ goal was to prospectively quantify the impact of resting-state functional MRI (rs-fMRI) on pediatric epilepsy surgery planning.METHODSFifty-one consecutive patients (3 months to 20 years old) with intractable epilepsy underwent rs-fMRI for presurgical evaluation. The team reviewed the following available diagnostic data: video-electroencephalography (n = 51), structural MRI (n = 51), FDG-PET (n = 42), magnetoencephalography (n = 5), and neuropsychological testing (n = 51) results to formulate an initial surgery plan blinded to the rs-fMRI findings. Subsequent to this discussion, the connectivity results were revealed and final recommendations were established. Changes between pre– and post–rs-fMRI treatment plans were determined, and changes in surgery recommendation were compared using McNemar’s test.RESULTSResting-state fMRI was successfully performed in 50 (98%) of 51 cases and changed the seizure onset zone localization in 44 (88%) of 50 patients. The connectivity results prompted 6 additional studies, eliminated the ordering of 11 further diagnostic studies, and changed the intracranial monitoring plan in 10 cases. The connectivity results significantly altered surgery planning with the addition of 13 surgeries, but it did not eliminate planned surgeries (p = 0.003). Among the 38 epilepsy surgeries performed, the final surgical approach changed due to rs-fMRI findings in 22 cases (58%), including 8 (28%) of 29 in which extraoperative direct electrical stimulation mapping was averted.CONCLUSIONSThis study demonstrates the impact of rs-fMRI connectivity results on the decision-making for pediatric epilepsy surgery by providing new information about the location of eloquent cortex and the seizure onset zone. Additionally, connectivity results may increase the proportion of patients considered eligible for surgery while optimizing the need for further testing.

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Spatiotemporal distribution and age of seizure onset in a pediatric epilepsy surgery cohort with cortical dysplasia

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106598 ◽

2021 ◽

Vol 172 ◽

pp. 106598 ◽

Cited By ~ 1

Author(s):

Natrujee Wiwattanadittakul ◽

Sirorat Suwannachote ◽

Xiaozhen You ◽

Nathan T. Cohen ◽

Tan Tran ◽

...

Keyword(s):

Epilepsy Surgery ◽

Cortical Dysplasia ◽

Spatiotemporal Distribution ◽

Pediatric Epilepsy ◽

Seizure Onset ◽

Pediatric Epilepsy Surgery

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Seizure outcome of pediatric epilepsy surgery

Neurology ◽

10.1212/wnl.0000000000008966 ◽

2020 ◽

Vol 94 (7) ◽

pp. 311-321 ◽

Cited By ~ 5

Author(s):

Elysa Widjaja ◽

Puneet Jain ◽

Lindsay Demoe ◽

Astrid Guttmann ◽

George Tomlinson ◽

...

Keyword(s):

Random Effects ◽

Medical Therapy ◽

Epilepsy Surgery ◽

Pediatric Epilepsy ◽

Seizure Outcome ◽

Seizure Freedom ◽

Incomplete Resection ◽

Seizure Onset ◽

Age At Surgery ◽

Pediatric Epilepsy Surgery

ObjectiveThis systematic review and meta-analyses assessed seizure outcome following pediatric epilepsy surgery.MethodsMEDLINE, EMBASE, and Cochrane were searched for pediatric epilepsy surgery original research from 1990 to 2017. The outcome was seizure freedom at 12 months or longer follow-up. Using random-effects models, the effect sizes for controlled studies, uncontrolled studies on surgery locations (temporal lobe [TL], extratemporal lobe [ETL], or hemispheric surgery), pathologies, nonlesional epilepsy, and incomplete resection were estimated. Meta-regression assessed the relationship between age at surgery, age at seizure onset, and seizure outcome. Random-effects network meta-analysis was conducted for surgery locations.ResultsTwo hundred fifty-eight studies were included. Surgery achieved higher seizure freedom than medical therapy (odds ratio [OR] = 6.49 [95% confidence interval [CI]: 2.87–14.70], p < 0.001). Seizure freedom declined over time after surgery, from 64.8% (95% CI: 51.2%–76.4%; p = 0.034) at 1 year, to 60.3% (95% CI: 52.9%–67.4%; p = 0.007) at 5 years, and to 39.7% (95% CI: 28.4%–52.2%, p = 0.106) at 10 years. Seizure freedom was (1) highest for hemispheric surgery, followed by TL and ETL surgery, and (2) highest for tumor and lower for malformations of cortical development. Seizure freedom was lower for nonlesional than lesional epilepsy (OR = 0.54 [95% CI: 0.34, 0.88], p = 0.013) and incomplete than complete resection (OR = 0.13 [95% CI: 0.08, 0.21], p < 0.001). Age at surgery and age at seizure onset were associated with seizure freedom for mixed pathologies and surgery locations and TL surgery.ConclusionEpilepsy surgery was more effective than medical therapy to control seizures. Understanding seizure outcomes of different surgery locations, pathologies, nonlesional epilepsy, and incomplete resection will assist with presurgical counseling.

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