Abstracts

Rationale: Epilepsy surgery is an important treatment option for patients with intractable epilepsy. However the surgical evaluation process can be complex and vulnerable to delay. This is not a trivial issue given the small but finite risk of SUDEP (Sudden Unexplained Death in Epilepsy Patients), as well as delaying the enhancement of quality of life that could be expected with successful epilepsy surgery. Although barriers to initiating the pre-surgical evaluation have previously been studied, there may be other delays once this evaluation has been initiated. To our knowledge, the delays during the epilepsy surgery evaluation have not been systematically analyzed. Therefore, this pilot project analyzed the interval between the intial evaluation of patients in the Epilepsy Monitoring Unit (EMU) and surgery, and determined the variables that most often lead to delays in treatment.Methods: A retrospective chart review of patients who had resective surgery performed at a Level 4 epilepsy center between 1/2008 and 12/2014 was conducted. Patients who had tumor surgery, or were presenting for a second epilepsy surgery were excluded. A chart review was then conducted on the remaining patients documenting dates of EMU admission(s), neuropsychology testing, Wada test(s), case conference (s), and surgery. The primary starting point was discharge from the initial EMU evaluation, and the primary end point was surgery. We analyzed the time from starting point to each variable in order to assess the relative delays.Results: A total of 105 patients reached the primary end point of resective surgery; 96 patients completed the Wada test, and 92 patients completed neuropsychology testing. The median time between EMU discharge and surgery was 280 days (mean= 491 days; SD= 681 days). The median time between EMU discharge and first neuropsychology testing was 60 days (mean= 205 days; SD= 585 days). The median time between EMU and the Wada test was 74 days (mean= 177 days; SD= 298 days). Lastly, the median time between EMU and the first epilepsy multi-disciplinary case conference was 124 days (mean= 255; SD= 577 days).Conclusions: We found that most patients completed the surgical evaluation process in less than 10 months. While heterogeneity exists in our cohort, some significant outliers may be more reflective of the patient’s own decision to delay surgery, as opposed to an intrinsic delay in the system. While no clear consensus exists for optimal duration of the epilepsy surgery evaluation, we believe that this is a reasonable time frame. Nevertheless, this data is helpful in further allocating resources to ensure that timely access to procedures is possible (i.e., the Wada test). Furthermore, this project is currently analyzing other diagnostic tests that could potentially delay surgery (e.g., MRI, PET scan, Ictal/Interictal SPECT scan, fMRI, etc.); results will be forthcoming. To our knowledge, this is the first large-scale systematic study which analyzes the variables that lead to delays in surgery and will lead to optimization of resources for the improvement of patient outcomes and quality of life.