Cargando…

Epilepsy center characteristics and geographic region influence presurgical testing in the United States

OBJECTIVE: Persons with drug‐resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This censu...

Descripción completa

Detalles Bibliográficos
Autores principales: Ahrens, Stephanie M., Arredondo, Kristen H., Bagić, Anto I., Bai, Shasha, Chapman, Kevin E., Ciliberto, Michael A., Clarke, Dave F., Eisner, Mariah, Fountain, Nathan B., Gavvala, Jay R., Perry, M. Scott, Rossi, Kyle C., Wong‐Kisiel, Lily C., Herman, Susan T., Ostendorf, Adam P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099541/
https://www.ncbi.nlm.nih.gov/pubmed/36317952
http://dx.doi.org/10.1111/epi.17452
_version_ 1785025074439389184
author Ahrens, Stephanie M.
Arredondo, Kristen H.
Bagić, Anto I.
Bai, Shasha
Chapman, Kevin E.
Ciliberto, Michael A.
Clarke, Dave F.
Eisner, Mariah
Fountain, Nathan B.
Gavvala, Jay R.
Perry, M. Scott
Rossi, Kyle C.
Wong‐Kisiel, Lily C.
Herman, Susan T.
Ostendorf, Adam P.
author_facet Ahrens, Stephanie M.
Arredondo, Kristen H.
Bagić, Anto I.
Bai, Shasha
Chapman, Kevin E.
Ciliberto, Michael A.
Clarke, Dave F.
Eisner, Mariah
Fountain, Nathan B.
Gavvala, Jay R.
Perry, M. Scott
Rossi, Kyle C.
Wong‐Kisiel, Lily C.
Herman, Susan T.
Ostendorf, Adam P.
author_sort Ahrens, Stephanie M.
collection PubMed
description OBJECTIVE: Persons with drug‐resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy. METHODS: We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and US Census regional data. We used Wilcoxon rank‐sum, Kruskal–Wallis, and chi‐squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables. RESULTS: The response rate was 100% with individual element missingness < 11% across 342 observations undergoing univariate analysis. A total of 278 complete observations were included in the multivariable models, and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR = 2.87, 95% confidence interval [CI] = 1.2–6.86; p = .018) and fluorodeoxyglucose–positron emission tomography (OR = 2.74, 95% CI = = 1.14–6.61; p = .025) more commonly. For centers in the Northeast (OR = .46, 95% CI = .23–.93; p = .031) and West (OR = .41, 95% CI = .19–.87; p = .022), odds of performing single‐photon emission computerized tomography were lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume, and resources were also associated with varying individual testing rates. SIGNIFICANCE: Presurgical testing for drug‐resistant epilepsy is influenced by US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment.
format Online
Article
Text
id pubmed-10099541
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-100995412023-04-14 Epilepsy center characteristics and geographic region influence presurgical testing in the United States Ahrens, Stephanie M. Arredondo, Kristen H. Bagić, Anto I. Bai, Shasha Chapman, Kevin E. Ciliberto, Michael A. Clarke, Dave F. Eisner, Mariah Fountain, Nathan B. Gavvala, Jay R. Perry, M. Scott Rossi, Kyle C. Wong‐Kisiel, Lily C. Herman, Susan T. Ostendorf, Adam P. Epilepsia Research Articles OBJECTIVE: Persons with drug‐resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy. METHODS: We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and US Census regional data. We used Wilcoxon rank‐sum, Kruskal–Wallis, and chi‐squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables. RESULTS: The response rate was 100% with individual element missingness < 11% across 342 observations undergoing univariate analysis. A total of 278 complete observations were included in the multivariable models, and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR = 2.87, 95% confidence interval [CI] = 1.2–6.86; p = .018) and fluorodeoxyglucose–positron emission tomography (OR = 2.74, 95% CI = = 1.14–6.61; p = .025) more commonly. For centers in the Northeast (OR = .46, 95% CI = .23–.93; p = .031) and West (OR = .41, 95% CI = .19–.87; p = .022), odds of performing single‐photon emission computerized tomography were lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume, and resources were also associated with varying individual testing rates. SIGNIFICANCE: Presurgical testing for drug‐resistant epilepsy is influenced by US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment. John Wiley and Sons Inc. 2022-11-14 2023-01 /pmc/articles/PMC10099541/ /pubmed/36317952 http://dx.doi.org/10.1111/epi.17452 Text en © 2022 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Research Articles
Ahrens, Stephanie M.
Arredondo, Kristen H.
Bagić, Anto I.
Bai, Shasha
Chapman, Kevin E.
Ciliberto, Michael A.
Clarke, Dave F.
Eisner, Mariah
Fountain, Nathan B.
Gavvala, Jay R.
Perry, M. Scott
Rossi, Kyle C.
Wong‐Kisiel, Lily C.
Herman, Susan T.
Ostendorf, Adam P.
Epilepsy center characteristics and geographic region influence presurgical testing in the United States
title Epilepsy center characteristics and geographic region influence presurgical testing in the United States
title_full Epilepsy center characteristics and geographic region influence presurgical testing in the United States
title_fullStr Epilepsy center characteristics and geographic region influence presurgical testing in the United States
title_full_unstemmed Epilepsy center characteristics and geographic region influence presurgical testing in the United States
title_short Epilepsy center characteristics and geographic region influence presurgical testing in the United States
title_sort epilepsy center characteristics and geographic region influence presurgical testing in the united states
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099541/
https://www.ncbi.nlm.nih.gov/pubmed/36317952
http://dx.doi.org/10.1111/epi.17452
work_keys_str_mv AT ahrensstephaniem epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT arredondokristenh epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT bagicantoi epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT baishasha epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT chapmankevine epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT cilibertomichaela epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT clarkedavef epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT eisnermariah epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT fountainnathanb epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT gavvalajayr epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT perrymscott epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT rossikylec epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT wongkisiellilyc epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT hermansusant epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT ostendorfadamp epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates
AT epilepsycentercharacteristicsandgeographicregioninfluencepresurgicaltestingintheunitedstates