Resident Geisinger Health System Danville, Pennsylvania, United States
Introduction: It is estimated that approximately 1.2% of the United States (US) population suffers from epilepsy. With such a high prevalence, multiple treatment modalities have been developed to treat this condition. Newer, less invasive approaches are becoming more common for epilepsy patients that have disease refractory to medication treatment. We aimed to characterize trends in surgical treatment for epilepsy refractory to medication in the US population using a large national database.
Methods: The National Inpatient Sample database was utilized from 2016 to 2018. Patients were selected by the diagnosis of medically refractory epilepsy, and then included if they underwent a surgical procedure. Patients with intracranial tumors were excluded. Surgical procedures analyzed were open resection, laser interstitial thermal therapy (LITT), radiotherapy (proton beam, stereotactic radiosurgery), and neurostimulation (deep brain stimulation, vagal nerve stimulation).
Results: A total of 730,121 patients were admitted with a diagnosis of medically refractory epilepsy. Of those, 4,862 (1.1%) patients underwent a surgical procedure. Resection was the most commonly performed procedure at 3,834 cases (84.1%), followed by neurostimulation at 837 cases (11.6%), LITT at 144 cases (2.4%), and radiotherapy at 47 cases (1.8%). Compared to other approaches, patients were more likely to receive neurostimulation if they were female (OR 1.2, 95% CI: 1.1-1.5), or at a teaching hospital (OR 4.4, 95% CI: 2.4-8.2). Patients were more likely to receive resection if they were above the median age (OR 2.7, 95% CI: 2.0-3.6), non-white race (OR 1.24, 95% CI: 1.04-1.46), below the median income level (OR 1.27, 95% CI: 1.0-1.5), hypertensive (OR 3.45, 95% CI: 1.9-6.3) or diabetic (OR 6.3, 95% CI: 2.7-14.3).
Conclusion : While resection remains a mainstay treatment in medically refractory epilepsy due to its efficacy, less invasive approaches are gaining popularity. Newer technologies such as LITT and stereotactic radiosurgery may become more common as their indications grow and morbidity decrease.
