title: Time to pediatric epilepsy surgery is related to disease severity and nonclinical factors.
abstract: OBJECTIVE
  To identify clinical and nonclinical factors associated with time from epilepsy onset to surgical evaluation and treatment among a cohort of children having epilepsy surgery.
  
  
  METHODS
  Data were abstracted from records of 430 children (younger than 18 years) who had epilepsy neurosurgery at the University of California, Los Angeles from 1986 to 2010. Multivariable Cox proportional hazards models were used to analyze unique associations of clinical severity, pre-referral brain MRI, and sociodemographic characteristics with time to surgery.
  
  
  RESULTS
  Shorter time to surgery was associated with active (hazard ratio [HR] 5.67, 95% confidence interval [CI] 3.74-8.70) and successfully treated infantile spasms (HR 2.20, 95% CI 1.63-2.96); daily or more seizures (HR 2.09, 95% CI 1.58-2.76); MRI before referral regardless of imaging findings (HR 1.95, 95% CI 1.47-2.58); private insurance (HR 1.54, 95% CI 1.14-2.09); and Hispanic ethnicity (HR 1.38, 95% CI 1.01-1.87). There were race/ethnicity by insurance interactions (log-rank p = 0.049) with shortest time to surgery for Hispanic children with private insurance.
  
  
  CONCLUSIONS
  Shorter intervals to surgical treatment were associated with greater epilepsy severity and insurance type, consistent with existing literature. However, associations of shorter times to treatment with having a brain MRI before referral and Hispanic ethnicity were unexpected and warrant further investigation. More knowledgeable referring providers and parents with greater help-seeking capability may explain obtaining an MRI before referral. Shorter intervals to surgery among Hispanic children may relate to the same factors yielding an increased volume of Hispanic children receiving surgery at the University of California, Los Angeles since 2000.
authors.affiliation: Departments of Neurology, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. cbower@mednet.ucla.edu
authors.forename: Christine B
authors.initials: CB
authors.lastname: Baca
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vassar
authors.forename: Jason S
authors.initials: JS
authors.lastname: Hauptman
authors.forename: Andrew
authors.initials: A
authors.lastname: Dadour
authors.forename: Taemin
authors.initials: T
authors.lastname: Oh
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: Harry V
authors.initials: HV
authors.lastname: Vinters
authors.forename: Raman
authors.initials: R
authors.lastname: Sankar
authors.forename: Gary W
authors.initials: GW
authors.lastname: Mathern
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019635:Neurosurgical Procedures; D012017:Referral and Consultation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome