Premium
Delays in time to surgery for minorities with temporal lobe epilepsy
Author(s) -
Thompson Atalie C.,
Ivey Susan L.,
Lahiff Maureen,
Betjemann John P.
Publication year - 2014
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12700
Subject(s) - temporal lobe , epilepsy , epilepsy surgery , medicine , psychology , neuroscience
Summary Objectives To determine whether adult minority patients with medically refractory temporal lobe epilepsy ( TLE ) experience significantly longer times to anterior temporal lobectomy ( ATL ) following presurgical evaluation. Methods A retrospective cohort study of 223 adult patients with epilepsy ( PWE ) and unilateral mesial temporal sclerosis who completed presurgical evaluation in the epilepsy monitoring unit at U niversity of C alifornia, S an F rancisco, between January 1, 1993 and December 31, 2010, with follow‐up through December 31, 2012. Log‐rank test was performed for Kaplan‐Meier survival curves of time to ATL stratified by race/ethnicity and by limited E nglish proficiency ( LEP ). Adjusted hazard ratios ( HR s) and 95% confidence intervals (CIs) were calculated using C ox p roportional h azards and W eibull modeling. Results African A mericans ( AAs ) and A sian/ P acific I slanders ( A sian/ PIs ) experienced significantly longer times to surgery than whites in K aplan‐ M eier plots (log‐rank test p = 0.02 and p = 0.005, respectively). AAs and A sian/ PIs also had longer times to surgery after adjusting for frailty, LEP , sex, age, mesial temporal sclerosis ( MTS) laterality, and nonconcordant ictal electroencephalography ( EEG) (adjusted HR = 0.22, p = 0.006; adjusted HR = 0.25, p = 0.003, respectively). Patients with LEP experienced significantly longer times to surgery than patients proficient in E nglish (log‐rank test p = 0.0085; adjusted HR = 0.48, p = 0.041). In C ox modeling, nonconcordant ictal EEG studies (adjusted HR = 0.47, p = 0.01), left‐sided MTS (adjusted HR = 0.69, p = 0.023), and female sex (adjusted HR = 0.72, p = 0.048) were risk factors for longer times to surgery. Significance A A and A sian/ PI patients as well as those with LEP have significantly longer times to ATL following presurgical evaluation. Future studies should be aimed at identifying the source of these disparities and developing targeted interventions to address them. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .