Abstracts

Rationale: Focal cortical dysplasia (FCD) comprises a group of pathological disorders characterized by malformations in cortical development. FCD is the most common cause of medically intractable epilepsy in pediatric patients, often requiring resective surgery for adequate seizure control. Previous studies have identified complete resection, partial seizures, temporal location, and type II histological classification as factors that influence surgical outcomes. However, there is limited data on the sociodemographic characteristics of FCD patients and their effect on postoperative seizure control. This study aimed to investigate the effect of sociodemographic factors on overall surgical outcomes and to characterize the clinical profile of FCD patients undergoing epilepsy surgery based on sociodemographic variables.  Methods: We retrospectively reviewed 96 patients who underwent surgery for medically intractable epilepsy and had evidence of FCD on MRI and/or histopathological analysis. Data collected included demographics, zip code, health insurance, seizure history, preoperative imaging, hospital course, and postoperative course. Patient zip code was used to classify geographical area as urban or rural, using census data and determine distance travelled to hospital. Postsurgical outcomes were evaluated with the Engel Epilepsy Surgery Outcome Scale at the first and last postoperative follow-up. Results: Racial minorities experienced worse postoperative seizure control at initial follow-up (p=0.04), but this difference did not persist at final follow-up. Postoperative complications were associated with late seizure recurrence (p=0.03). Higher rates of readmission were observed in patients with government-funded health insurance compared to private insurance and self-pay (p=0.01). There were no significant differences in measures of seizure burden, seizure type, or postoperative complications that could account for difference in readmission rates. Patients with government-funded insurance had the shortest travel distance for surgery (p=0.04). Shorter travel distance was associated with an older age at surgery (p <0.001) and longer duration of epilepsy prior to surgery (p<0.0001).  Conclusions: This study demonstrates that FCD patients vary in important demographic and clinical factors that influence the postoperative course and long-term outcomes following resective epilepsy surgery. The most notable findings include differences based on health insurance and travel distance. Our results demonstrate that lower economic status and proximity to surgical center are important predictors of hospital readmission and how early patients pursue surgical management of intractable epilepsy. Funding: Not applicable