Abstracts

Rationale: Medically-refractory temporal lobe epilepsy (TLE) is a common and devastating neurological condition. In 2001, the first randomized, controlled trial of anterior temporal lobectomy (ATL) for intractable TLE demonstrated its superior efficacy over continued medical therapy. Subsequent guidelines recommended surgical evaluation for medically-refractory TLE patients, but it is unknown if practice has changed accordingly. Methods: We performed a retrospective cohort study with time trends of patients admitted to U.S. hospitals for TLE between 1990 and 2008 who did or did not receive ATL, as reported in the Nationwide Inpatient Sample. Results: Weighted data revealed 112,026 national hospitalizations for TLE and 6,653 ATLs from 1990 to 2008. A trend of increasing TLE admissions over the study period was not accompanied by an increase in ATLs, producing a significant trend of decreasing ATL rates (adjusted R squared = 0.41, P < 0.01) (see Figure 1). Factors underlying this trend included a decrease in TLE hospitalizations at the highest-volume epilepsy centers, and increased admissions to lower-volume hospitals less likely to perform the procedure. White patients were significantly more likely to receive ATL than racial minorities, and privately insured individuals were more likely to have surgery than those with Medicaid or Medicare.Conclusions: Despite class I evidence and subsequent guidelines, the utilization of ATL for TLE has not increased from 1990 to 2008. Significant disparities exist in the surgical treatment of TLE related to race and insurance coverage.