ORLANDO, Fla. ― Black and Hispanic children and those on Medicaid are less likely to have surgery to treat drug-resistant epilepsy than white children and those with private insurance, even though the treatment is often more effective than medication alone, suggests a study of more than 18,000 children presented at the American Epilepsy Society Annual Meeting.
All children in the study were taking antiseizure medications (ASMs). After 10 years, those who also had vagus nerve stimulation (VNS) were 35% more likely to be alive and those who also had cranial surgery were 83% more likely to be alive than those who were only taking ASMs, researchers determined.
“For the first time, we measured the impact of treatments for drug-resistant epilepsy in children and found that surgical care is associated with longer survival and yet there are disparities in who gets this care,” said Sandi Lam, MD, MBA, lead author of the study and division chief of pediatric neurosurgery at Ann & Robert H. Lurie Children’s Hospital of Chicago. “I think we can all agree it is not OK that certain groups of people are less likely to get surgical treatments that can help them live longer.”
The study included 18,292 children who were treated for drug-resistant epilepsy at one of 49 US pediatric hospitals from 2004-2020. Of those, 10,240 children were treated with ASMs only, 5,019 received ASMs and VNS, and 3,033 received ASMs and cranial epilepsy surgery. There was a significant difference in the distribution of race, ethnicity, and insurance among the three types of treatment groups. A higher proportion of patients in the cranial surgery group had private insurance compared to the other two groups. The proportion of non-Hispanic white individuals was significantly larger than that of other races and ethnicities in the cranial surgery and VNS treatment groups, suggesting that non-Hispanic white individuals are more likely to receive surgical treatment of any kind.
For VNS, a device is placed under the skin of the chest and sends electrical impulses to the area of the brain responsible for the seizures through the vagus nerve. Cranial surgery involves removing or disconnecting the part of the brain where the seizures occur.