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Association Between Characteristics of National Association of Epilepsy Centers and Reported Utilization of Specific Surgical Techniques.

OBJECTIVE
Nearly one third of persons with epilepsy will continue having seizures despite trialing multiple antiseizure medications. Epilepsy surgery may be beneficial in these cases, and evaluation at a comprehensive epilepsy center is recommended. Numerous palliative and potentially curative approaches exist, and types of surgery performed may be influenced by center characteristics. This article describes epilepsy center characteristics associated with epilepsy surgery access and volumes in the U.S.


METHODS
We analyzed National Association of Epilepsy Centers 2019 annual report and supplemental survey data obtained with responses from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Surgical treatment volumes were compiled with center characteristics, including U.S. Census region. We used multivariable modeling with zero-inflated Poisson regression models to present odds ratios and incidence rate ratios of receiving a given surgery type based on center characteristics.


RESULTS
The response rate was 100% with individual element missingness less than 4% across 352 observations undergoing univariate analysis. Multivariable models included 319 complete observations. Significant regional differences were present. Rates of laser interstitial thermal therapy (LITT) were lower at centers in the Midwest (IRR 0.74, 95% CI 0.59-0.92; p = 0.006) and the Northeast (IRR 0.77, 95% CI 0.61-0.96; p = 0.022) compared to those in the South. Conversely, responsive neurostimulation (RNS) implantation rates were higher in the Midwest (IRR 1.45, 95% CI 1.1-1.91; p = 0.008) and West (IRR 1.91, 95% CI 1.49-2.44; p < 0.001) compared to the South. Center accreditation level, institution type, demographics, and resources were also associated with variations in access and rates of potentially curative and palliative surgical interventions.


INTERPRETATION
Epilepsy surgery procedure volumes are influenced by U.S. epilepsy center region and other characteristics. These variations may impact access to specific surgical treatments for persons with drug resistant epilepsy across the U.S.