Abstract Details

Title Equity in Surgical Management of Refractory Epilepsy – Where Are We?

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 10-003

Objective To compare 20-year trends in resection and neurostimulator use among patients with refractory epilepsy (RE) in the United States.

Background Surgical resection (SR) and neurostimulator placement (NP) remain key treatments for RE. Despite these advances including antiseizure medications (ASM), recent racial/ethnic trends in epilepsy care are poorly defined.

Design/Methods Retrospective analyses were conducted using the TriNetX US Collaborative Network, encompassing 71 healthcare organizations (2005 - 2025) and patients aged 18 - 80. Two periods were compared: 2005–2015 and 2015–2025. Primary endpoints were SR (CPT 1009097) and NP (CPT 1009263). Cohorts included Asian, Black, Hispanic, Native American (NA), and Non-Hispanic White (NHW) patients. Risk ratios (RRs) were calculated between racial/ethnic groups using NHW as reference, matched for age, sex, and ASM use.

Results Among 1,327,254 RE patients, SR and NP rates were 1.5% and 1.7%, respectively. From 2005 - 2015 to 2015 - 2025, SR declined from 1.8% to 1.2% (RR 0.51, p < 0.0001), and NP from 1.8% to 1.5% (RR 0.83, p < 0.0001). Across 20 years, NHW patients had higher SR and NP rates than Black (1.7% vs 1.1%; 1.9% vs 1.2%) and NA patients (1.7% vs 0.8%; 1.9% vs 1.0%), all p < 0.0001. Differences between NHW and Hispanic patients were insignificant for SR (1.55% vs 1.52%; RR 0.98, p = 0.54) and NP (1.7% vs 1.7%; RR 0.99, p = 0.76). Asian patients showed higher SR (1.6% vs 2.0%; RR 1.21, p < 0.001) and NP (1.7% vs 2.1%; RR 0.82, p = 0.002) rates compared with NHW. Intra-racial analyses revealed declining procedural rates in all but Asian patients.

Conclusions

Over two decades, SR and NP interventions for RE declined among all groups except Asian patients. NHW patients consistently exhibited higher intervention rates. Persistent racial and ethnic disparities highlight the need to identify underlying factors and develop strategies promoting equitable access to epilepsy surgery.

Authors/Disclosures
Adeolu O. Morawo, MD PRESENTER	Dr. Morawo has nothing to disclose.
Michael I. Nsaka, MD, PhD (Penn State Neuroscience Institute)	Dr. Nsaka has nothing to disclose.
Alain Z. Lekoubou Looti, MD (Penn StateHealth, Hershey Medical Center)	Dr. Lekoubou Looti has nothing to disclose.

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