Abstracts

Rationale:
Epilepsy surgery is underutilized. In settings where epilepsy surgery is utilized, what are the barriers to timely surgery and why does it matter? Timely surgery for patients with intractable epilepsy can affect outcomes. A longer duration of epilepsy has been shown to affect long term-outcomes with negative effect on development, cognition, and seizure outcomes in specific populations (Beatty et al., 2021).




At a pediatric institution in the Midwest, epilepsy providers refer patients who have undergone a surgical evaluation for intractable epilepsy to be presented at the Multidisciplinary Epilepsy Surgery Conference (MESC). The discussion and proposed outcome can lead to a variety of interventions including focal resection, hemispherotomy, corpus callosotomy, laser interstitial thermal therapy (LiTT), and neuromodulation (Jehi, et al., 2022).




Post MESC, patients are scheduled for a visit with neurosurgery prior to surgery. A quality improvement initiative was implemented to assess if a coordinated joint telemedicine preoperative visit with epilepsy and neurosurgery would impact time to surgery.




Methods: A retrospective chart review was performed to identify patients who had been presented at MESC, deemed as surgical candidates, and underwent surgery from 1/2023-1/2024. Age of patient, gender, and date presented at MESC were collected. Time from MESC to surgery was collected and comparison made between those who had a joint visit versus those who did not.

Results:
A total of 54 patients were identified (33 males, 21 females). The mean age was 10.4 years.




Time from MESC to surgery was an average of 93 days. A joint clinic occurred for 22/54 (41%) of the patients and the average time to surgery for these patients was 62 days. There was no joint visit for 32/54 (59%) of the patients and the average time to surgery for these patients was 115 days.




VNS was placed in 20/54 (37%) patients, the remainder 34/54 (63%) underwent any combination of resection, hemispherotomy, corpus callosotomy, LiTT, RNS or DBS. Joint visits occurred for 22/54 (41%).




Conclusions:
A review was performed on patients who underwent a surgical evaluation for their intractable epilepsy and were presented at MESC and then proceeded with epilepsy surgery.




Those with joint clinic visit were seen in clinic sooner and underwent epilepsy surgery nearly two times sooner than those who did not have a joint visit.




This review suggests that joint visits between the epilepsy and neurosurgery team with families can aid in improving time to epilepsy surgery. The joint visit has been successful; however, it has not been universally implemented. Limits to the utilization of this clinic need to be investigated. Further evaluation of additional factors is needed to assess other underlying causes of delay from time of presentation at conference to time of surgery.




Funding: n/a