National Trends in the Treatment of Refractory Epilepsy: A Nationwide Inpatient Sample–Based Propensity Score Matching Analysis.

Introduction: Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. Our study aims to analyze the national trends in different treatment modalities for individuals with drug-resistant epilepsy (DRE), and investigate the outcomes associated with these procedural trends in the United States.

Methods: Patients with focal intractable epilepsy who had LITT, open surgical resection, VNS, or RNS were identified using the 2010–2020 Nationwide Inpatient Sample (NIS) database. Hospital and demographic data were used to examine discharge disposition, duration of stay, complications, and mortality. Pre-pandemic and pandemic (first COVID-19 peak) outcomes were compared using propensity score matching. Trend analysis used piecewise joinpoint regression.

Results: This study included 33,969 hospitalizations for focal intractable epilepsy, with 3,343 patients undergoing surgical resection (N = 2602; 77.83%), VNS (N = 274; 8.21%), RNS (N = 262; 7.83%), and LITT (N = 205; 6.13%). A few (N = 357; 10.67%) of these individuals were treated during the COVID pandemic (2020), but most (N = 2,986; 89.32%) were treated before the pandemic. Of all treated patients, 91 (2.7%) developed postoperative neurologic problems and 11 (0.3%) died. After propensity-score matching, 658 patients were included, 329 pre- and post-pandemic. Two patients (0.6%) suffered subarachnoid hemorrhages and 23 (7%) experienced preoperative paralysis/aphasia during the pandemic, compared to the pre-pandemic rate of 12 (1.8%) (p < 0.001). Pre- and post-pandemic neurologic problems, discharge disposition, and LOS were not statistically different (p = 0.13), 0.12, and 0.44, respectively. However, the pandemic death rate was higher than pre-pandemic (N = 4; 1.2% vs. N = 1; 0.2%; p = 0.026).

Conclusion : Our analysis shows that focal intractable epilepsy diagnosis is rising and resections are falling, with LITT and RNS utilization growing gradually. Patient demographics showed majority had private insurance and few COVID-19 problems. These findings emphasize the necessity of expanding DRE treatment options and improving access to surgery for eligible patients. More study is needed to determine treatment modality choices and improve patient outcomes and quality of life.