Inequalities in the utilisation of epilepsy surgery for adults and children in Canada

Background: Epilepsy surgery is likely underutilised. Our goal was to study the utilisation of epilepsy surgery in the general population, using Canada as a model of a high-income country with universal medical coverage. Methods: We systematically identified all epilepsy surgery centres in Canada that were active in 2015. A standardised questionnaire was completed by every centre. Descriptive statistics are reported. Comparisons were made to a 2003 survey of paediatric epilepsy surgery. Results: Twelve adult and 11 paediatric epilepsy surgery centres were identified, performing a total of 456 and 206 surgical procedures, respectively, in 2015. Adult centres were in only six of 10 provinces; paediatric centres were in seven. Two thirds of adult centres and one third of paediatric centres were high-volume centres. Per capita volume per province varied between 7.0 and 20.5 therapeutic surgeries per million adult residents, and between 7.8 and 48.4 per million paediatric residents. Temporal lobe resections accounted for 59.8% and 33.5% of all adult and paediatric treatments, respectively. Eleven adult and nine paediatric centres possessed facilities to carry out intracranial investigations but only six and two, respectively, performed at least six intracranial implantations in 2015. There was a modest increase in the per capita number of paediatric surgeries between 2003 and 2015. Conclusions: There is dramatic inter-centre and interprovincial variability in the epilepsy services available and the type of surgical interventions performed with significant gaps identified in some regions. Our findings are pivotal for the future optimisation of care offered to this vulnerable patient population.