To determine the social drivers of health (SDOH) that impact time from diagnosis of drug-resistant epilepsy (DRE) to completion of surgical treatment in pediatric patients with epilepsy at a broad catchment hospital in Northern California.

About 20-40% of epilepsy patients are diagnosed with DRE. Patients with DRE who meet criteria and complete surgery have vastly improved seizure control and quality of life. However, surgery remains an underutilized treatment option and access may be influenced by SDOH. Understanding the variables that delay treatment is crucial for reducing morbidity and mortality in patients with DRE.

Demographic data was gathered from pediatric patients (≤ 25 years) with DRE who had undergone surgical epilepsy treatment from 2018-2025. Time from DRE diagnosis to surgical completion was calculated from the encounter in which the patient’s seizures could not be controlled with two anti-seizure medications to the day of the surgery. Time to surgery and ten SDOH factors were analyzed using one-way ANOVA and log-rank test.

Analysis was done on 95 patients (66% male). Public health insurance (n=70, x¯=74 months) was associated with longer time to surgery compared to private insurance (n=15, x¯=37.7 months, p=0.045). Patients living in urban zip codes with population >50,000 (n=24, med=135.1 months) had longer times to surgery than patients in rural zip codes with population <10,000 (n=16, med=32.5 months, p=0.015). There was no significant association between race, age, patient/parent language, median household income, distance from hospital, comorbidities, and IEP with time from DRE diagnosis to surgery. 

Public health insurance and urban zip code are associated with longer disease duration and significant delays in completing surgical evaluation and treatment. Further studies are needed to explore the implications of these findings in Northern California’s diverse communities and address ways to eliminate disparities in access, leading to improved seizure outcomes for pediatric patients with epilepsy.