Epileptic disorders : international epilepsy journal with videotape · 2025
Latency to presentation after seizure onset and drug resistance to a comprehensive epilepsy center in an urban tertiary care center.
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Srinivas Meghana, Lucas Kristen, Weber Rebecca, Millis Scott, Elsayed Mona, Zutshi Deepti, Basha Maysaa M, Marawar Rohit
Аннотация
OBJECTIVE: To evaluate latency to presentation among persons with epilepsy at an urban National Association of Epilepsy Centers Level IV epilepsy center and assess the impact of socioeconomic status and race on this latency. Less than 1% of persons with epilepsy are referred to specialized centers in the United States, often taking over twenty years to undergo surgery, significantly affecting quality of life and healthcare costs. Our primary objective was to assess latency to presentation at our Level IV epilepsy clinic in Detroit, Michigan. The secondary objective was to evaluate the impact of low socioeconomic status and Black race on latency to presentation.
METHODS: We retrospectively analyzed persons with epilepsy seen at our clinic in 2014, excluding those previously seen at an epilepsy center. Persons with epilepsy were divided into drug-resistant epilepsy and non-drug-resistant epilepsy groups. We calculated latency to presentation for all patients and both groups and assessed drug resistance for the drug-resistant epilepsy group. Regression models were fitted using latency to presentation as the outcome variable.
RESULTS: A total of 648 unique persons with epilepsy were seen, with 408 included in the analysis. Among these, 66.42% were Black, and 63.72% had low socioeconomic status. The drug-resistant epilepsy group had more patients with known etiology and temporal lobe epilepsy (p < 0.05). The mean latency to presentation was 13.21 years for all patients and 16.04 years for the drug-resistant epilepsy group; since drug resistance, it was 14.74 years. Persons with low socioeconomic status showed longer latency, but significance did not persist after regression. No differences were found between Black and White persons.
SIGNIFICANCE: Optimal epilepsy care in the United States remains delayed with first presentation to the epilepsy clinic taking more than 13 years. Future studies should explore reasons for these delays rather than focusing solely on epilepsy surgery referrals.
METHODS: We retrospectively analyzed persons with epilepsy seen at our clinic in 2014, excluding those previously seen at an epilepsy center. Persons with epilepsy were divided into drug-resistant epilepsy and non-drug-resistant epilepsy groups. We calculated latency to presentation for all patients and both groups and assessed drug resistance for the drug-resistant epilepsy group. Regression models were fitted using latency to presentation as the outcome variable.
RESULTS: A total of 648 unique persons with epilepsy were seen, with 408 included in the analysis. Among these, 66.42% were Black, and 63.72% had low socioeconomic status. The drug-resistant epilepsy group had more patients with known etiology and temporal lobe epilepsy (p < 0.05). The mean latency to presentation was 13.21 years for all patients and 16.04 years for the drug-resistant epilepsy group; since drug resistance, it was 14.74 years. Persons with low socioeconomic status showed longer latency, but significance did not persist after regression. No differences were found between Black and White persons.
SIGNIFICANCE: Optimal epilepsy care in the United States remains delayed with first presentation to the epilepsy clinic taking more than 13 years. Future studies should explore reasons for these delays rather than focusing solely on epilepsy surgery referrals.