Sponsor
NIH U-RISE
First Advisor
Jan Just
Date of Award
Spring 5-15-2024
Document Type
Thesis
Degree Name
Bachelor of Science (B.S.) in Public Health Studies: Clinical Health Sciences
Language
English
Subjects
Drug-resistant epilepsy, rural health disparities, epilepsy care access, genetic testing, epilepsy surgery, specialized neurological care.
Abstract
Drug-resistant epilepsy (DRE) is associated with significant morbidity and worsened outcomes when access to specialized epilepsy care is delayed. Rural populations may face additional barriers to neurological evaluation, genetic testing, and epilepsy surgery due to geographic and healthcare access limitations. This retrospective cohort study evaluated disparities in epilepsy care timelines among rural and urban patients treated at Oregon Health & Science University (OHSU), one of Oregon’s two Level 4 epilepsy centers. Electronic health record data were reviewed for 110 patients, including 80 urban and 30 rural patients. Variables included age at seizure onset, age at genetic testing, age at epilepsy monitoring unit (EMU) admission, age at first epilepsy surgery, and type of first surgical intervention. Descriptive statistics, matched cohort analysis, and independent two-sample t-tests assuming unequal variances were used to compare cohorts.
Both cohorts demonstrated prolonged delays in access to advanced epilepsy care. Rural patients experienced longer mean delays to genetic testing (25.9 vs. 24.2 years) and epilepsy surgery (22.0 vs. 17.7 years) compared with urban patients, along with greater variability in timing of care. Although statistical significance was not identified, rural patients consistently demonstrated trends toward delayed access to specialized epilepsy evaluation and treatment. Vagus nerve stimulation (VNS) was the most common first surgical intervention overall, while rural patients demonstrated a higher proportion of sEEG/SEEG procedures.
These findings highlight persistent delays in epilepsy care across both patient populations and suggest that rural patients may experience additional barriers to timely specialty evaluation and surgical intervention. This study contributes Oregon-specific evidence to the growing literature on disparities in epilepsy care and emphasizes the importance of improving access to specialized neurological services.
Recommended Citation
Madani, Bahar and Kellogg, Marissa, "Disparities between rural and urban patients with epilepsy in Oregon from time of seizure onset to genetic testing and surgical treatment" (2024). University Honors Theses. Paper 1883.