Racial disparities in the utilization of invasive neuromodulation devices for the treatment of drug‐resistant focal epilepsy

• Published in: Epilepsia (Copenhagen) 2024-05, Vol.65 (5), p.e61-e66
• Main Authors: Alcala‐Zermeno, Juan Luis, Fureman, Brandy, Grzeskowiak, Caitlin L., Potnis, Ojas, Taveras, Maria, Logan, Margaret W., Rybacki, Delanie, Friedman, Daniel, Lowenstein, Daniel, Kuzniecky, Ruben, French, Jacqueline
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Black or African American - statistics & numerical data; deep brain stimulation; Deep Brain Stimulation - methods; Deep Brain Stimulation - statistics & numerical data; Drug Resistant Epilepsy - therapy; Epilepsies, Partial - ethnology; Epilepsies, Partial - therapy; Epilepsy; epilepsy surgery; Female; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Humans; Inequality; inequity; Male; Middle Aged; Neuromodulation; Patients; Population studies; Prospective Studies; Race; Racial differences; responsive neurostimulation; United States; vagus nerve stimulation; White People - statistics & numerical data; Young Adult
• ISSN: 0013-9580; 1528-1167; 1528-1167
• DOI: 10.1111/epi.17961

Racial disparities affect multiple dimensions of epilepsy care including epilepsy surgery. This study aims to further explore these disparities by determining the utilization of invasive neuromodulation devices according to race and ethnicity in a multicenter study of patients living with focal drug‐resistant epilepsy (DRE). We performed a post hoc analysis of the Human Epilepsy Project 2 (HEP2) data. HEP2 is a prospective study of patients living with focal DRE involving 10 sites distributed across the United States. There were no statistical differences in the racial distribution of the study population compared to the US population using census data except for patients reporting more than one race. Of 154 patients enrolled in HEP2, 55 (36%) underwent invasive neuromodulation for DRE management at some point in the course of their epilepsy. Of those, 36 (71%) were patients who identified as White. Patients were significantly less likely to have a device if they identified solely as Black/African American than if they did not (odds ratio = .21, 95% confidence interval = .05–.96, p = .03). Invasive neuromodulation for management of DRE is underutilized in the Black/African American population, indicating a new facet of racial disparities in epilepsy care.