Abstracts

Rationale: In pediatric patients with intractable epilepsy, surgical evaluation is recommended given the detrimental effects of ongoing frequent seizures. The COVID-19 pandemic greatly disrupted healthcare delivery, and the goal of this study was to determine how the pandemic directly impacted presurgical evaluation of pediatric epilepsy patients who ultimately had resective surgery at a level 4 epilepsy center in the United States.

Methods: Through retrospective chart review, we evaluated 44 pediatric ( < 21 years old) patients with intractable epilepsy who underwent presurgical evaluation and ultimately epilepsy surgery from 3/10/2017 - 1/15/2021; there were 25 patients who underwent evaluation prior to the pandemic and 19 who underwent evaluation during the pandemic. We used Wilcoxon rank sum tests to compare the length of time to completion of each individualized step (up to 16 steps per patient) prior to March 17, 2020 (the onset of the COVID-19 pandemic) to patients who underwent evaluation and surgery during the ongoing pandemic.

Results: In comparing pre-pandemic to pandemic data points, initiation of phase 1 monitoring was found to be delayed in the pandemic cohort (median 34 days pre-pandemic compared to 179 days in the pandemic cohort, p = 0.003). The median time from initial presentation at refractory epilepsy conference (REC) to the REC where surgery was recommended was also delayed in the pandemic cohort (0 days pre-pandemic and 129.5 days in the pandemic cohort, p = 0.006). Other evaluations that were delayed in the pandemic cohort were time to MRI, neuropsychological testing, PET scan completion (and report), MEG scan completion, and SPECT scan completion, though these results were not statistically significant. Overall, the median time from referral for pre-surgical workup to surgical resection was 705 days in the pre-pandemic cohort compared to 754 days in the pandemic cohort. Completion of speech-language pathology evaluation was not delayed.

Conclusions: This study highlights the areas most impacted by the COVID-19 pandemic for patients who ultimately underwent resective surgery for intractable epilepsy. In evaluation of a total of 16 steps along the pathway to epilepsy surgery, the statistically significant delays during the COVID-19 pandemic in our cohort of patients were seen in 2 domains: time to completion of phase 1 monitoring and the time from initial presentation at REC to the final REC when surgery was recommended. This is not surprising, given that elective hospital admissions and surgeries were cancelled during the initial phase of the pandemic for approximately 3 months. Delays were seen in other steps that did not reach statistical significance, though our results may be limited by the overall small sample size of our cohort. Surprisingly, there was no delay in outpatient referrals to speech and language evaluations, attributed to this being done virtually. This study provides novel insights into how the ongoing pandemic has negatively impacted presurgical evaluation of pediatric patients with intractable epilepsy, while also highlighting a positive change our center made (virtual SLP evaluations) that helped expedite patient care during the pandemic.

Funding: Please list any funding that was received in support of this abstract.: Capstone for Impact Grant, University of Michigan Medical School.