Abstracts

Rationale: Surgery is an option for children with refractory epilepsy, but it is offered to less than 50% of them. This study tries to understand if the clinical approach to epilepsy surgery is different at a tertiary care center in a large metropolitan area. Methods: A retrospective review was conducted for 32 patients who were evaluated for epilepsy surgery here. The data analyzed included: epilepsy history; diagnostic work-up; socioeconomic factors, to determine whether they affected the time to surgical evaluation. Results: Mean age of seizure onset was 5.3y (SD=4.3). Workup for epilepsy diagnosis included EEG, MRI, PET, and SPECT. The mean age at first EEG was 6.1y (SD=4.5). The mean number of EEGs per patient was 8.2 (SD=6.9). Mean number of EEG days was 20.3 (SD=15.5). 30 had initially abnormal EEGs. A mean of 4.9 MRIs were performed (SD=2.2). Mean age at first MRI was 6.2y (SD=5.2). 19 were abnormal. Of the 13 normal studies, 3 were repeated with epilepsy protocol and were abnormal. 14 patients had at least one PET, and 12 had at least one SPECT. The mean age at surgery evaluation was 12.9 (SD=4.9). Mean age at the time of epilepsy surgery was 12.7 (SD=5.1). The mean time from seizure onset to surgery evaluation was 7.3y (SD=5.0), and the mean time from evaluation to surgery was 0.2y (SD=0.6). 5 were noted to have seizures daily, 4 weekly, and 2 monthly. For patients with initially normal MRIs, the mean time between onset and evaluation was 9y (SD=5). For those with initially abnormal MRIs, the mean time was 6.3y (SD=4.8). 25 patients were referred from the faculty practice and 7 from the resident clinic. Mean time to surgery evaluation from the faculty practice was 7.9y (SD=5.5); from the resident clinic, it was 9.8y (SD=5). With regard to race, of the 32 patients referred for epilepsy surgery evaluation, 12 were reported white, 5 black, 5 Hispanic, 2 Asian. Respectively, mean times from onset to evaluation for each group were: 8.3y (SD=5.7); 6y (SD=5.1); 4y (SD=2.5); 3y (SD=1.4). 54% of patients had commercial insurance, and 46% had a government-supported health plan; the time from onset to evaluation was 8.3y (SD=5.5) and 6.5y (SD=4.6) respectively. At the time of evaluation, patients were prescribed 3 (SD=0.9) AEDs, and the average number of failed AEDs per patient was 4 (SD=3.2). Pathology reports demonstrated cortical dysplasia in 16; tumor in 1; MTS in 4, microgliosis in 7; TSC in 3. After surgery, 26 patients were Engel class 1; 3 were Engel class 2; and 3 were Engel class 4. Conclusions: Even at our large, metropolitan, tertiary referral center, a delay exists in the time from seizure onset to surgery evaluation in pediatric patients. Children with frequent seizures, abnormal MRIs, who were referred by the faculty practice were evaluated earlier. Patients with commercial insurance had a longer delay than those with other insurance, but this may be due to consultation with multiple centers. Additional work is needed to characterize the attributes of each patient to ensure equitable, expedient access to comprehensive evaluation for potential epilepsy surgery treatment. Funding: none