Intractable pediatric temporal lobe epilepsy in the United States: examination of race, age, sex, and insurance status as factors predicting receipt of resective treatment

Object. For patients with intractable temporal lobe epilepsy (ITLE), resection of the temporal lobe has been proven to be far superior to continued medical management. The goal of this study was to evaluate on a national level whether race and other sociodemographic factors are predictors of receipt of resective treatment for pediatric ITLE. Methods. A retrospective cohort study was performed using the Kids' Inpatient Database covering the period of 1997 through 2003. Only children admitted for resection for ITLE (ICD-9-CM 345.41, 345.51; primary procedure code 01.53) were included. Variables studied included patient race, age, sex, and primary payer. Results. Multivariate analyses revealed no significant difference in the odds of undergoing resection for ITLE for black children compared with nonblack children (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.28-1.53, p = 0.327), or between female and male children (OR 1.11, 95% CI 0.76-1.63, p = 0.586). Older children were more likely to undergo resection for ITLE (OR 1.07, 95% CI 1.03-1.11, p < 0.001 per 1 year increase in age), as were children with private insurance (OR 2.21, 95% CI 1.34-3.63, p = 0.002). Conclusions. In this first nationwide analysis of pediatric ITLE, older age and private insurance status independently predicted which children were more likely to receive surgical treatment for ITLE on a national level, whereas sex did not. Black children with ITLE were no less likely to receive surgical intervention than nonblack children. Future nationwide analyses will be required to determine whether these trends for pediatric ITLE surgery remain stable over time.