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Abstract
Objective: To assess the use of epilepsy surgery in patients with medically intractable epilepsy in a publicly funded universal health care system.
Methods: We performed a population-based retrospective cohort study using linked health care databases for Ontario, Canada, between 2001 and 2010. We identified all patients with medically intractable epilepsy, defined as those with seizures that did not respond to at least 2 adequate trials of seizure medications. We assessed the proportion of patients who had epilepsy surgery within the following 2 years. We further identified the characteristics associated with epilepsy surgery.
Results: A total of 10,661 patients were identified with medically intractable epilepsy (mean age 47 years, 51% male); most (74%) did not have other comorbidities. Within 2 years of being defined as medically intractable, only 124 patients (1.2%) underwent epilepsy surgery. Death occurred in 12% of those with medically intractable epilepsy. Those who underwent the procedure were younger and had fewer comorbidities compared to those who did not.
Conclusion: In our setting of publicly funded universal health care, more than 10% of patients died within 2 years of developing medically intractable epilepsy. Epilepsy surgery may be an effective treatment for some patients; however, fewer than 2% of patients who may have benefited from epilepsy surgery received it.
GLOSSARY
- CI=
- confidence interval;
- CIHI-DAD=
- Canadian Institute for Health Information Discharge Abstract Database;
- ICD=
- International Classification of Diseases;
- ICES=
- Institute for Clinical and Evaluative Sciences;
- ILAE=
- International League Against Epilepsy;
- NARCS=
- National Ambulatory Care Reporting System;
- ODB=
- Ontario Drug Benefits;
- OHIP=
- Ontario Health Insurance Plan;
- RPDB=
- Registered Persons Database;
- RR=
- relative risk;
- VNS=
- vagus nerve stimulator
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received May 2, 2015.
- Accepted in final form August 28, 2015.
- © 2015 American Academy of Neurology
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