From the Department of Pediatrics (A.P.O., S.M.A.), Nationwide Children's Hospital and Ohio State University, Columbus; Department of Neurology (F.A.L.), Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY; Department of Pediatrics (S.T.A.), Children's Medical Center, Dallas, TX; Pediatric Biostatistics Core (S.B.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (M.K.B.O.), University of Kentucky, Lexington; Department of Child Health (K.E.C.), University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital; Division of Pediatric Neurology (D.F.C.), Department of Neurology, Dell Medical School, University of Texas at Austin; Biostatistics Resource at Nationwide Children's Hospital (M.E.), Columbus, OH; Department of Neurology (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; National Association of Epilepsy Centers (J.M.G., E.R., B.V.S.), Washington, DC; University of Maryland Medical Center (J.L.H.), Baltimore, MD; Ken and Ruth Davee Department of Neurology (S.U.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Neurology (S.T.H.), Barrow Neurological Institute, Phoenix, AZ.
Neurology. 2022 Feb 1;98(5):e449-e458. doi: 10.1212/WNL.0000000000013130. Epub 2021 Dec 8.
Patients with drug-resistant epilepsy (DRE) may benefit from specialized testing and treatments to better control seizures and improve quality of life. Most evaluations and procedures for DRE in the United States are performed at epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). On an annual basis, the NAEC collects data from accredited epilepsy centers on hospital-based epilepsy monitoring unit (EMU) size and admissions, diagnostic testing, surgeries, and other services. This article highlights trends in epilepsy center services from 2012 through 2019.
We analyzed data reported in 2012, 2016, and 2019 from all level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level and center population category. EMU beds, EMU admissions, epileptologists, and aggregate procedure volumes were also described using rates per population per year.
During the period studied, the number of NAEC accredited centers increased from 161 to 256, with the largest increases in adult- and pediatric-only centers. Growth in EMU admissions (41%), EMU beds (26%), and epileptologists (109%) per population occurred. Access to specialized testing and services broadly expanded. The largest growth in procedure volumes occurred in laser interstitial thermal therapy (LiTT) (61%), responsive neurostimulation (RNS) implantations (114%), and intracranial monitoring without resection (152%) over the study period. Corpus callosotomies and vagus nerve stimulator (VNS) implantations decreased (-12.8% and -2.4%, respectively), while growth in temporal lobectomies (5.9%), extratemporal resections (11.9%), and hemispherectomies/otomies (13.1%) lagged center growth (59%), leading to a decrease in median volumes of these procedures per center.
During the study period, the availability of specialty epilepsy care in the United States improved as the NAEC implemented its accreditation program. Surgical case complexity increased while aggregate surgical volume remained stable or declined across most procedure types, with a corresponding decline in cases per center. This article describes recent data trends and current state of resources and practice across NAEC member centers and identifies several future directions for driving systematic improvements in epilepsy care.
耐药性癫痫（DRE）患者可能受益于专门的测试和治疗，以更好地控制癫痫发作并提高生活质量。在美国，大多数 DRE 的评估和程序都是在国家癫痫中心协会（NAEC）认证的癫痫中心进行的。每年，NAEC 都会从认证的癫痫中心收集有关医院癫痫监测单元（EMU）规模和入院、诊断测试、手术和其他服务的数据。本文重点介绍了 2012 年至 2019 年癫痫中心服务的趋势。
我们分析了 2012 年、2016 年和 2019 年所有 3 级和 4 级 NAEC 认证的癫痫中心报告的数据。使用类别变量的频率和连续变量的中位数来描述数据，并按中心级别和中心人群类别进行分析。还使用每年每人口的比率描述了 EMU 床位、EMU 入院、癫痫专家和综合手术量。
在研究期间，NAEC 认证的中心数量从 161 个增加到 256 个，成人和儿科专用中心的增长幅度最大。人口增长率分别为 EMU 入院（41%）、EMU 床位（26%）和癫痫专家（109%）。专门测试和服务的获取广泛扩大。在研究期间，激光间质热疗（LiTT）（61%）、反应性神经刺激（RNS）植入物（114%）和无切除颅内监测（152%）的手术量增长最大。胼胝体切开术和迷走神经刺激器（VNS）植入术分别减少了（-12.8%和-2.4%），而颞叶切除术（5.9%）、颞外切除术（11.9%）和半球切除术/切开术（13.1%）的增长滞后于中心增长（59%），导致每个中心的这些手术的中位数手术量减少。
在研究期间，随着 NAEC 实施其认证计划，美国专业癫痫治疗的可及性得到了改善。手术病例的复杂性增加，而大多数手术类型的总手术量保持稳定或下降，每个中心的病例数量相应减少。本文描述了 NAEC 成员中心最近的数据趋势以及当前资源和实践状况，并确定了推动癫痫护理系统改进的几个未来方向。
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