Distance travelled affects time to surgery in kids with focal cortical dysplasia
Sociodemographic factors appear to be important determinants of time to epilepsy surgery for children with focal cortical dysplasia (FCD), a new study has shown.
Researchers conducted a retrospective review of 94 consecutive paediatric patients (median age at seizure onset, 3.0 years) with FCD who underwent surgery for epilepsy. Factors assessed included seizure history, preoperative imaging, travel distance, and health insurance, among others. Postsurgical outcomes were evaluated using the Engel Epilepsy Surgery Outcome Scale.
The average follow-up after surgery was 24 months, during which time 58 of the participant underwent neuropsychological evaluation with IQ testing. Most of the participants resided within the state where the medical centre was located, while 20 had to travel from out of state. Majority (73 percent) had private insurance, while 21 percent were government-insured. Five percent were uninsured.
Patients were then grouped according to distance travelled to hospital. For those within the same state, the median distance was 30.7 miles. Those who travelled below the median distance tended to be older (p=0.005) and had a longer duration of epilepsy prior to the operation (p=0.01). These patients were also more likely to have focal to bilateral tonic-clonic seizures than their out-of-state counterparts (p=0.04).
Moreover, the median number of failed antiseizure medications was significantly lower in those who travelled within the state (below the median distance: 2.00±2.14; above the median distance: 2.00±1.61; out-of-state: 3.00±2.37; p=0.06).
However, univariate and multivariate analyses did not find distance travelled, health insurance, and other demographic factors to be significantly predictive of seizure control after surgery.
“Further research is warranted to target barriers in access to subspecialty care and develop programs to identify earlier the patients who may benefit from workup and deployment of surgical intervention,” said researchers.