Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA.
Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Epilepsia. 2024 May;65(5):1314-1321. doi: 10.1111/epi.17944. Epub 2024 Mar 8.
Delay in referral for epilepsy surgery of patients with drug-resistant epilepsy (DRE) is associated with decreased quality of life, worse surgical outcomes, and increased risk of sudden unexplained death in epilepsy (SUDEP). Understanding the potential causes of delays in referral and treatment is crucial for optimizing the referral and treatment process. We evaluated the treatment intervals, demographics, and clinical characteristics of patients referred for surgical evaluation at our level 4 epilepsy center in the U.S. Intermountain West.
We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation.
Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001).
Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.
耐药性癫痫（DRE）患者的癫痫手术转诊延误与生活质量下降、手术结果恶化以及癫痫不明原因猝死（SUDEP）风险增加有关。了解转诊和治疗延误的潜在原因对于优化转诊和治疗过程至关重要。我们评估了在美国山间西部的 4 级癫痫中心接受手术评估的患者的治疗间隔、人口统计学和临床特征。
我们回顾性审查了 2012 年至 2022 年间接受 DRE 手术的患者的记录。收集的数据包括患者人口统计学、DRE 诊断日期、临床特征、保险状况、距癫痫中心的距离、手术评估日期、手术程序以及不同评估阶段之间的间隔。
在我们的 185 例癫痫患者队列中（99 名女性，53.5%），手术时的平均年龄±标准差（SD）为 38.4±11.9 岁。在该队列中，95.7%的患者接受了确定性癫痫手术（最常进行神经调节手术），4.3%的患者参加了第 2 阶段颅内监测但尚未接受确定性手术。观察到的中位数（1 分位数-3 分位数）间隔为从癫痫诊断到 DRE 诊断 10.1（3.8-21.5）年，从癫痫诊断到手术 16.7（6.5-28.4）年，从 DRE 诊断到手术 1.4（0.6-4.0）年。我们观察到，到我们的癫痫中心治疗的距离较远的患者从癫痫诊断到 DRE 诊断（p<.01）和癫痫诊断到手术（p<.05）的中位时间明显缩短。接受公共医疗保险的患者从 DRE 诊断到手术的时间明显延长（p<.001）。
到我们的癫痫中心的距离较短和公共医疗保险均预测了诊断和治疗间隔的延迟。及时将 DRE 患者转诊到专门的癫痫中心进行手术评估至关重要，确定可能导致转诊延迟的关键因素对于优化手术结果至关重要。
