Surgery for treatment of temporal lobe epilepsy varies among ethnic groups

04/21/04

SAN FRANCISCO African Americans are less than half as likely as non-Hispanic whites to undergo surgery for temporal lobe epilepsy, according to research that will be presented at the American Academy of Neurology 56th Annual Meeting in San Francisco, Calif., April 24 - May 1, 2004.

The difference in surgery rates is independent of other demographic, socioeconomic, and clinical variables, including availability of medical insurance, according to lead study author Jorge Burneo, MD, of the Epilepsy Center at University of Alabama at Birmingham Medical Center.

Surgery for medically intractable temporal lobe epilepsy "is no longer an intervention of last resort," said Burneo, and is often considered early because it may lead to freedom from seizures. When the condition is due to mesial temporal sclerosis (MTS), the surgery has a demonstrated success rate of 60 percent in randomized controlled trials, and up to 93 percent in descriptive studies. MTS, which is among the most common causes of temporal lobe epilepsy, is characterized by cell loss and structural changes in parts of the brain called the hippocampus and amygdala.

At the same time, he said, multiple studies have documented differences in the use of treatments by African Americans and whites in the use of different treatments for a variety of conditions.

To assess whether the same pattern is true in surgery for epilepsy, Burneo and colleagues reviewed the charts of 122 patients with temporal lobe epilepsy with evidence of MTS on their brain scans. While African Americans constituted 25 percent of temporal lobe epilepsy patients at the Epilepsy Center, they accounted for only 9 percent of surgery patients. Even after controlling for age, education, seizure onset variables, and type of medical insurance, African Americans were still 56 percent less likely to undergo surgery than non-Hispanic whites.

"Race appears to be an important factor related to such disparities," Burneo said, "but the causes remain unclear, and they appear not to be related to a difference in access to care."

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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