Time Course of Delays to Adult Epilepsy Surgery: A Single-center Experience
Abstract number :
3.451
Submission category :
9. Surgery / 9A. Adult
Year :
2024
Submission ID :
454
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Ofek Avidor, MD – The Ohio State University
Debolina Kanjilal, MD – The Ohio State University
Presenting Author: A. LeBron Paige, MD – The Ohio State University
Jaysingh Singh, MD – The Ohio State University Wexner Medical Center
Rationale: A prolonged duration of presurgical evaluation contributes to epilepsy-related morbidity and mortality. We sought to determine the timeframe of delays to adult epilepsy presurgical evaluation so that institutions using preoperative multidisciplinary patient assessment teams might better anticipate and address these potential delays.
Methods: We retrospectively identified adult patients with drug-resistant epilepsy (DRE), which was discussed at the epilepsy surgery conference (ESC) during the study period of 2019-2024 at The Ohio State University. We studied the time course from patients deemed potential surgical candidates in the clinic to finish the Phase I presurgical evaluation, ESC recommendations (e.g., can proceed to resection or neuromodulation or require more data like intracranial EEG), and patients receiving the definite surgical treatment after icEEG.
Results: Of the 137 adult patients with DRE discussed in the ESC during the study period, 61% (n=84) completed the entire presurgical evaluation and received definite surgical treatment. Among Phase I presurgical testing, EMU (epilepsy monitoring unit) for scalp EEG seizure localization (mean: 68 days [SD ± 71]) and Neuropsychology testing (mean: 74 [ SD± 88]) evaluation took more extended time than MRI brain (mean: 46 days [ SD±68] and PET Brain (mean: 41 days [SD±41]). The median time interval from being deemed a surgical candidate in the clinic to being discussed in ESC and receiving ESC-recommended treatment was 167 days and 393 days, respectively. We found significant delays in receiving definite surgery (resection or ablation) if the patient required iEEG with a mean of 530 days (± SD 390 days).
Conclusions: At a single NAEC level IV epilepsy center, most delays to adult epilepsy surgery occur during the Phase I presurgical testing, particularly with EMU and neuropsychology cognitive evaluation, which leads to significant delays in receiving definite surgical treatment. Further research is needed to develop a structured protocol to reduce delays and promptly complete the required presurgical evaluation.
Funding: This study was entirely internally funded
Surgery