Professor of Neurology and Epidemiology Western University London, Ontario, Canada
This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session
Rationale: It is recommended that patients are assessed for epilepsy surgery candidacy upon diagnosis of refractory epilepsy; however, rates of assessment and receipt remain low. Our objective was to determine if rates of both assessment and receipt are similarly low for patients with stroke-related refractory epilepsy and to identify factors associated with these outcomes. Methods: We used linked, administrative healthcare databases to conduct a population-based retrospective cohort study of adult Ontario, Canada residents discharged from an Ontario acute care institution for treatment of a stroke between January 1, 1997 and December 31, 2017 without prior evidence of seizures. We excluded patients who did not subsequently develop pharmacologically refractory epilepsy within five years of their first prescription for an antiseizure medication. We estimated the rates of epilepsy surgery assessment and receipt by December 31, 2019 and described the cohort by sociodemographic characteristics, comorbidities, and features of their epilepsy presentation and treatment. We planned to use Cox proportional hazards regression models to identify covariates independently associated with our outcomes. Results: A total of 444 patients (193 women, mean age: 73.8±6.7 years) were included, nine (0.02%, 4.6 per 1,000 person-years) of whom were assessed for epilepsy surgery candidacy and none received the surgery before the end of follow-up. The mean number of adequate pharmacological trials was 3.1 (SD=1.6) and time between epilepsy and refractory epilepsy diagnoses was 647.75 (SD=590.69) days. Given the small number of events observed, we did not proceed with the planned multivariable analyses. Conclusions: We identified few stroke survivors with new-onset refractory epilepsy who were assessed for epilepsy surgery, none of whom received the surgery by the end of follow-up. These findings indicate that stroke-related refractory epilepsy patients in Ontario are infrequently considered for a surgery that could reduce morbidity and mortality. Funding: Please list any funding that was received in support of this abstract.: Lawson Health Research Institute, Western University and its Schulich School of Medicine and Dentistry, the Jack Cowin Endowed Chair in Epilepsy Research, ICES Western, Ontario’s Ministry of Health and Long-Term Care, the Academic Medical Organization of Southwestern Ontario, and the Canadian Institutes of Health Research.
