Abstracts

Rationale: To examine the effect of geographic location in Saskatchewan on time between diagnosis of intractable epilepsy and referral to the Saskatchewan Epilepsy Centre, located in Saskatoon, as well as its effect on wait times for epilepsy surgery. Methods: All cases of epilepsy surgery in Saskatchewan were reviewed from 2008 to 2018. Three groups were defined to represent where patients were from. The first two groups, which consisted of patients from Saskatchewan’s two major cities, Saskatoon and Regina, were compared to the third group, consisting of patients from the remainder of Saskatchewan (mainly rural areas). Time from diagnosis of intractable epilepsy to referral to the epilepsy centre by a primary care provider was calculated and compared between the regions, as well as wait times from first assessment at the epilepsy centre to epilepsy surgery. Clinical outcomes following epilepsy surgery were also compared between patients from Saskatoon and the remainder of Saskatchewan. Results: 97 patients were recruited. Mean patient age was 37 years. The mean time from diagnosis of drug-resistant epilepsy to referral to the epilepsy centre was 12.9 years for patients from Saskatoon, 15.3 years for patients from Regina, and 19.3 years for patients from the remainder of Saskatchewan. Therefore, patients from Saskatoon were referred an average of 6.4 years faster than patients from rural Saskatchewan (p = 0.038), and patients from Regina were referred on average 4 years faster than their rural counterparts (p = 0.357). Mean wait times for further investigation following referral to the epilepsy centre were not statistically different between the groups: wait times from referral to first assessment at the epilepsy centre were 5 months for Saskatoon patients, 6 months for Regina patients, and 8 months for the remainder; first assessment to neuropsychological testing 9 months, 7 months, and 13 months respectively; first assessment to EEG 12 months, 8 months, and 11 months; first assessment to neurosurgical consult 17 months, 14 months, and 15 months; and first assessment to epilepsy surgery 26 months, 21 months, and 29 months. Rates of seizure freedom following epilepsy surgery were 72% at 6 months for patients from Saskatoon and 74% for patients from the remainder of Saskatchewan; and 69% at one year for Saskatoon patients and 72% for patients from the remainder. Differences in outcomes were not statistically significant.  Conclusions: This is the first study examining the time from diagnosis of intractable epilepsy to epilepsy surgery focusing on the influence of geographic location on overall wait times and outcomes. Patients from Saskatoon were found to have a statistically significant faster referral time to the epilepsy centre when compared to the remainder of Saskatchewan, but patients from Regina did not. Other wait times and clinical outcomes did not differ between the groups. These results suggest the main barrier to accessing epilepsy surgery for Saskatchewan’s rural community is the delay in referral, rather than delayed wait times once contact has been established with the epilepsy centre. Funding: None