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Abstract：
OBJECTIVE: Delay in referral for epilepsy surgery of patients with drug-resistant epilepsy (DRE) is associated with decreased quality of life, worse surgical outcomes, and increased risk of sudden unexplained death in epilepsy (SUDEP). Understanding the potential causes of delays in referral and treatment is crucial for optimizing the referral and treatment process. We evaluated the treatment intervals, demographics, and clinical characteristics of patients referred for surgical evaluation at our level 4 epilepsy center in the U.S. Intermountain West.
METHODS: We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation.
RESULTS: Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001).
CONCLUSIONS: Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.
METHODS: We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation.
RESULTS: Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001).
CONCLUSIONS: Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.
摘要：
目的：耐药癫痫（DRE）患者的癫痫手术转诊延迟与生活质量下降有关，更差的手术结果，并增加癫痫(SUDEP)猝死的风险。了解转诊和治疗延迟的潜在原因对于优化转诊和治疗过程至关重要。我们评估了治疗间隔，人口统计，以及在我们位于美国西部山区的4级癫痫中心进行手术评估的患者的临床特征。
方法：我们回顾性回顾了2012年至2022年接受DRE手术的患者记录。收集的数据包括患者人口统计学，DRE诊断日期,临床特征,保险状况,距离癫痫中心，手术评估的日期，外科手术,以及不同评估阶段之间的间隔。
结果：在我们的185名癫痫患者（99名女性，53.5%），手术时的平均±标准差(SD)年龄为38.4±11.9岁.在这个队列中，95.7％的患者接受了确定性癫痫手术（最常见的神经调节程序），4.3％的患者参与了2期颅内监测，但尚未接受确定性手术。从癫痫诊断到DRE诊断的中位数（第1-第3四分位数）间隔为10.1（3.8-21.5）年，从癫痫诊断到手术的16.7（6.5-28.4）年，从DRE诊断到手术1.4（0.6-4.0）年。我们观察到从癫痫诊断到DRE诊断（p<.01）和癫痫诊断到手术（p<.05）的中位时间显着缩短。有公共健康保险的患者从DRE诊断到手术的时间明显更长（p<.001）。
结论：前往我们的癫痫中心的较短距离和公共健康保险都预示着诊断和治疗间隔的延迟。及时将DRE患者转诊到专门的癫痫手术评估中心至关重要，确定可能延迟转诊的关键因素对于优化手术结局至关重要.
方法：我们回顾性回顾了2012年至2022年接受DRE手术的患者记录。收集的数据包括患者人口统计学，DRE诊断日期,临床特征,保险状况,距离癫痫中心，手术评估的日期，外科手术,以及不同评估阶段之间的间隔。
结果：在我们的185名癫痫患者（99名女性，53.5%），手术时的平均±标准差(SD)年龄为38.4±11.9岁.在这个队列中，95.7％的患者接受了确定性癫痫手术（最常见的神经调节程序），4.3％的患者参与了2期颅内监测，但尚未接受确定性手术。从癫痫诊断到DRE诊断的中位数（第1-第3四分位数）间隔为10.1（3.8-21.5）年，从癫痫诊断到手术的16.7（6.5-28.4）年，从DRE诊断到手术1.4（0.6-4.0）年。我们观察到从癫痫诊断到DRE诊断（p<.01）和癫痫诊断到手术（p<.05）的中位时间显着缩短。有公共健康保险的患者从DRE诊断到手术的时间明显更长（p<.001）。
结论：前往我们的癫痫中心的较短距离和公共健康保险都预示着诊断和治疗间隔的延迟。及时将DRE患者转诊到专门的癫痫手术评估中心至关重要，确定可能延迟转诊的关键因素对于优化手术结局至关重要.
