Shifts in epilepsy treatment: a 12-year review of surgical approaches and outcomes in lesional and nonlesional epilepsy.

Abstract

Epilepsy is a prevalent neurological disorder with significant morbidity. Lesional and nonlesional epilepsies, distinguished by the presence or absence of identifiable brain lesions, exhibit differences in patient characteristics and treatment approaches. This study aimed to compare treatment modalities, patient demographic characteristics, and outcomes between lesional and nonlesional epilepsy patients in the United States. This retrospective study utilized the National Inpatient Sample (NIS) database from 2009 to 2020. Adult patients diagnosed with lesional or nonlesional epilepsy who received vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS), resective surgery, radiosurgery, or laser interstitial thermal therapy (LITT) were included. Propensity score matching addressed baseline differences between the groups. Trends in treatment modalities, length of stay, total charges, mortality, and routine discharge were analyzed. Lesional epilepsy patients were significantly older, more likely to be male, and had higher comorbidity burdens compared to nonlesional epilepsy patients. Trends in treatment modalities varied, with VNS use declining in nonlesional epilepsy while RNS and LITT increased in both groups. Resective surgery increased in nonlesional epilepsy, while DBS and radiosurgery decreased in both groups. LITT was associated with decreased length of stay. RNS and LITT were associated with a higher likelihood of routine discharge. All surgical interventions were associated with increased total charges. Lesional and nonlesional epilepsy patients exhibit distinct demographic and clinical characteristics, influencing treatment selection and outcomes. The increasing use of RNS and LITT reflects the emergence of new technologies for epilepsy management. These findings highlight the need for tailored treatment approaches based on lesion etiology and individual patient needs. Future research should focus on long-term effectiveness and cost-effectiveness of different surgical interventions for both lesional and nonlesional epilepsy.