Publications

Want to read more about the topic? Related research papers on epilepsy and epilepsy surgery from the team are easy for you to access here. Check back as we grow the resource library over time!

$Authors: Lu Zhang, Matt Hall, Sandi Lam Abstract: Objectives: Refractory epilepsy is a diagnosis of recurrent seizures that requires multiple resources for optimal chronic management. The disease negatively impacts the lives of affected patients and families and poses an economic burden to the health care system. This study compares hospital costs between pediatric patients treated with antiseizure medications (ASMs) only and ASMs plus vagus nerve stimulation (VNS). Methods: Patients 0-17 years of age who were diagnosed with refractory epilepsy between January 1, 2011 and December 31, 2016, were identified from the Children's Hospital Association's Pediatric Health Information System (PHIS) database. Patients treated with ASMs only or ASMs plus VNS were included in the study and were followed 1!year prior and 2!years after meeting pre- determined criteria for refractory epilepsy. The difference- in- difference (DID) approach along with the two- part model was used to compare the changes in mean hospital costs captured in the PHIS database over time between the two cohorts. Results: One thousand one hundred thirteen patients treated with ASMs plus VNS and 3471 patients treated with ASMs only were included. At a follow- up time of 2 years, for the ASMs- only cohort, the adjusted all- cause and epilepsy-related mean annual total costs increased by $14715 (95% confidence interval [CI]: $12375-$17055) and $18437 (95% CI: $15978-$20896), respectively. By comparison, the adjusted all- cause and epilepsy- related mean annual total costs of the ASMs plus VNS cohort increased by $12838 (95% CI: $8171-$17505) and $15183 (95% CI: $10253-$20113), respectively. Compared to ASMs only, ASMs plus VNS generated a cost savings of $3254 for epilepsy- related annual costs per year after the index date. Significance: Compared to ASMs alone, ASMs plus VNS is a treatment modality associated with lower annual hospital costs over time. Our study shows that VNS is a cost- beneficial treatment for a national cohort of pediatric patients with refractory epilepsy.$

$Authors: Lu Zhang, Joyce W. Yu, Sandi Lam Abstract: Objectives: Refractory epilepsy imposes a substantial burden on affected patients, families, and healthcare system. In terms of treating seizures in children, vagus nerve stimulation (VNS) has been proved to be comparable to that of antiepileptic drugs (AEDs). This study compared healthcare resource utilization between pediatric patients treated with AEDs only and AEDs plus VNS. Methods: Pediatric patients diagnosed with refractory epilepsy between the 1st of January 2011 and the 31st of December 2016 were identified from the Pediatric Health Information System Database. Patients treated with AEDs only or AEDs plus VNS were included in the study and were followed up from one year before to two years after the date when defined criteria for refractory epilepsy were met. The difference-in-difference approach along with the hurdle model was used to compare the changes in healthcare resource utilization over time between patients treated with AEDs only and AEDs plus VNS. Results: The study included 1502 patients treated with AEDs plus VNS and 4541 patients treated with AEDs only. There was a difference in post-index all-cause and epilepsy-related inpatient visits compared to the pre-index period: inpatient hospitalizations were decreased in the AEDs plus VNS cohort, and increased in the AEDs only cohort. There was no significant difference in the pre-index to post-index change for all-cause and epilepsy-related emergency department visits between the two treatment cohorts. For outpatient encounters in the initial post-index period, patients treated with AEDs plus VNS had significantly higher increase in all-cause and epilepsy-related outpatient visits compared to the AEDs only cohort. Conclusions: Compared to those treated with AEDs only, pediatric patients with refractory epilepsy treated with AEDs plus VNS have fewer inpatient visits and more outpatient visits within a 2-year follow-up. Given the lower acuity of care in outpatient versus inpatient settings, this study can inform treatment choices for children with refractory epilepsy.$

$Authors: Iwen Pan, PhD, Melissa A. LoPresti, MD, MPH, Dave F. Clarke,MD, Sandi Lam, MD,MBA Abstract: BACKGROUND: Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. OBJECTIVE: To show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS: The Pediatric Health Information System database was used to conduct a cohort study using 5 published algorithms. Refractory epilepsy patients treated with antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery between 1/1/2008 and 12/31/2014 were included. Healthcare utilization following the index date at 2 and 5 yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used tomatch surgically andmedically treated patients. PS. SAS R 9.4 and Stata 14.0were used for data management and statistical analysis. RESULTS: A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated. A total of 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2 and 5 yr postindex date, therewas a reduction of 36% to 37% of inpatient visits and 47% to 50%of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were reduced by 39% to 43% in the surgical group compared to the medically treated group. In those who had surgery, the average reduction in AEDs was 16%at 2 and 5 yr after treatment. CONCLUSION: Patients with refractory epilepsy treatedwith surgery had significant reductions in healthcare utilization compared with patients treated only with medications.$

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