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The rate of pediatric epilepsy surgery has increased significantly in the United States during the past decade, according to an investigation published in the March issue of Epilepsia. Nevertheless, epilepsy surgery remains an underutilized treatment in children with epilepsy, according to the researchers.
“Continued emphasis on highlighting awareness of epilepsy surgery among pediatricians and pediatric neurologists is as important as ever, as they serve as the main gatekeepers for patients to access specialized epilepsy care,” said Elia M. Pestana Knight, MD, a neurologist at the Cleveland Clinic Epilepsy Center.
An Analysis of a Pediatric Database
Research indicates that the rate of epilepsy surgery in adults has either declined or remained stable in the past decade. Dr. Pestana Knight and colleagues, however, hypothesized that rates of epilepsy surgery in the pediatric population had increased over time. To test this hypothesis, the investigators performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database (KID) from 1997 to 2009. They calculated the rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year based on the number of prevalent epilepsy cases in the corresponding year. The researchers also estimated age-, race-, and sex-adjusted rates of surgeries.
Dr. Pestana Knight’s group used the Mann-Kendall trend test to identify changes in the rates of surgeries over time. Multivariable regression analysis enabled the group to estimate the effects of time, age, race, and sex on the annual incidence of epilepsy surgery.
Surgeries Increased in All Patient Subgroups
The number of epilepsy surgeries increased steadily from 375 in 1997 to 706 in 2009. The increase in surgeries occurred in all age groups except infants. Whites had the greatest number of surgeries, compared with blacks, Hispanics, and other minorities. Children with private insurance also had the highest number of surgeries performed, compared with children in public insurance programs and children with “other” payers (a category that included the uninsured).
The number of surgeries for each study year was less than 35% of children who are expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. After the investigators adjusted for age, race, sex, and changes in population distribution during the study period, the rates of pediatric epilepsy surgeries increased significantly from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009.
Although the rate of surgery increased in all patient subgroups, the increase was lowest among black children (compared with other races) and among children with public insurance (compared with children with private insurance). Age, race, and sex were independent predictors of surgery. Findings related to race should be interpreted with caution, said the researchers, because some hospitals and states do not provide data on race to the Healthcare Cost and Utilization Project, which encompasses KID.
“This is the first study that provides national estimates of pediatric epilepsy surgery utilization in the United States,” said Dr. Pestana Knight. “An increasing trend of surgical rates in publicly insured children with epilepsy is a hopeful finding that access to specialized epilepsy care in low-income children or patients’ and physicians’ perception and understanding of surgical treatment have improved. … Our findings emphasize that improving access to specialized epilepsy care for all children with epilepsy is as important as ever.”
—Erik Greb