488 National Trends in the Treatment of Refractory Epilepsy: A Nationwide Inpatient SampleBased Propensity Score Matching Analysis

Abstract

INTRODUCTION: Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. METHODS: Using the NIS database from 2010-2020, patients with focal intractable epilepsy who underwent Laser Interstitial Thermal Therapy (LITT), open surgical resection, Vagal Nerve Stimulation (VNS), or Responsive Neuro-Stimulation (RNS) were identified. Outcomes such as discharge disposition, length of stay, complications, and mortality were analyzed. Propensity score matching was used to compare outcomes between pre-pandemic and pandemic (first peak of COVID-19) periods. RESULTS: A total of 33,969 focal intractable epilepsy cases were found with 3,343 patients receiving different treatment modalities including surgical resection (77.83%), VNS (8.21%), RNS (7.83%), and LITT (6.13%). Most of these patients (89.32%) were treated during the pre-COVID pandemic era (2010-2019), while a minority (10.67%) underwent treatment during the COVID pandemic (2020). Among all treated patients, 2.7% had postoperative neurologic complications and 0.3% died. After propensity-score matching, 658 patients (329 in each group) were included. During the pandemic period, 7% presented with preoperative paralysis/aphasia, and 0.6% had subarachnoid hemorrhages, which was significantly higher than the pre-pandemic rate (1.8%; p < 0.001). There were no statistical differences in neurologic complications, discharge disposition, or LOS between the pre-pandemic and pandemic periods. On the other hand, the mortality rate was slightly higher during the pandemic compared to the pre-pandemic period (N = 4; 1.2% vs. N = 1; 0.2%; p = 0.026). CONCLUSIONS: Our study shows an increase in the diagnosis of focal intractable epilepsy and a decrease in resections, while LITT and RNS usage is rising. Improving access to surgery and encouraging newer treatment modalities for DRE is crucial. Further research is needed to optimize patient outcomes and identify factors that influence treatment choices.