Factors Influencing Delay in Epilepsy Surgery: A Retrospective Data Review for a Tertiary Referral Center

Ghasan Ahmad, Muhammad W Masud, Ping Li


Medically intractable focal epilepsy affects a third of patients with seizures which are potentially surgically remediable. Several factors have been suggested for the reasons of the delays in epilepsy surgery. Nationally, the average time to surgery after onset of seizures is 20 years. We analyzed the characteristics of population of patients in Western New York who underwent surgery for refractory epilepsy, the time duration between onset of epilepsy and surgery, and the factors influencing the time duration, in order to determine whether there is any difference between the data from Western New York and all states in United States of America. Retrospective chart review of 51 patients was performed on the patients diagnosed with refractory epilepsy from 2003-2014 who underwent surgery at our center. Demographic Data such age, gender, ethnicity, insurance information, seizure severity, number of medications, EEG results, MRI lesions, and time to surgery were collected. Linear regression forward model was used for analysis with significance value set at 0.05. Mean waiting time to surgery at our center was shorter (13.5 versus 20 years) compared to the other centers in the United States of America. Eighty-one% (37) of the patients were diagnosed with lesions on MRI, of which 13% (6) were tumors. Mean waiting time of patients with a lesion was 13.4 years versus 15.5 years for patients without a lesion. Mean time for pediatric patients was 4.5 years and while for an adult patient was 21 years. When linear regression forward model was applied, a shorter time to surgery was associated with pediatric patients with B = 11.81 (2.42, 21.2), p-value = 0.016. Our study suggests that pediatric patients underwent surgeries earlier compared to adult population, which may be due to earlier identification by the local pediatric neurologists. Further research with bigger sample size is needed to probe the factors influencing the time duration between onset of epilepsy and candidacy of epilepsy surgery.


epilepsy surgery, refractory epilepsy, delay

Full Text:



Benbadis SR, Tatum WO, Vale FL. When drugs don't work: an algorithmic approach to medically intractable epilepsy. Neurology. 2000;55:1780-1784.

Engel J. Surgery for Seizures. New England Journal of Medicine. 1996;334:647-653.

Engel J, Jr. The timing of surgical intervention for mesial temporal lobe epilepsy: A plan for a randomized clinical trial. Archives of Neurology. 1999;56:1338-1341.

Benbadis SR, Chelune, G.J., Stanford, L. The treatment of Epilepsy: Principles and practice. 3rd edn ed. Philadelphia: Lippincott, Williams & Wilkins; 2001.

Begley CE AJ, Lairson DR, Reynolds TF, Hauser WA. Cost of epilepsy in the United States: a model based on incidence and prognosis. Epilepsia. 1994;35:1230-1243.

Engel J, Wiebe S, French J, et al. Practice parameter: Temporal lobe and localized neocortical resections for epilepsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology, in Association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology. 2003;60:538-547.

Health NIo. Surgery for Epilepsy. NIH concensus statement 1990; http://consensus.nih.gov/1990/1990SurgeryEpilepsy077html.htm, 2015.

Engel J Jr SD. Who should be considered a surgical candidate? In: Engel J, ed. Surgical treatment of the epilepsies. 2nd ed ed. New York: Raven Press; 1993:23-24.

Englot DJ. The persistent under-utilization of epilepsy surgery. Epilepsy research. 2015;118:68-69.

Szaflarski M. Social determinants of health in epilepsy. Epilepsy & behavior: E&B. 2014;41:283-289.

Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51:1069-1077.

Li P, Ghadersohi S, Jafari B, Teter B, Sazgar M. Characteristics of refractory vs. medically controlled epilepsy patients with obstructive sleep apnea and their response to CPAP treatment. Seizure. 2012;21:717-721.

Hoh BL, Chapman PH, Loeffler JS, Carter BS, Ogilvy CS. Results of Multimodality Treatment for 141 Patients with Brain Arteriovenous Malformations and Seizures: Factors Associated with Seizure Incidence and Seizure Outcomes. Neurosurgery. 2002;51:303-311.

Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. The Lancet. Neurology. 2014;13:1114-1126.

Englot DJ. Epilepsy surgery trends in the United States: Differences between children and adults. Epilepsia. 2015;56:1321.

Hindi-Ling H, Kipervasser S, Neufeld MY, et al. Epilepsy Surgery in Children Compared to Adults. Pediatric Neurosurgery. 2011;47:180-185.

Engel J. Why Is There Still Doubt to Cut It Out? Epilepsy Currents. 2013;13:198-204.

Neligan A. Temporal trends in epilepsy surgery. European Journal of Neurology. 2014;21:814-815.


  • There are currently no refbacks.