Available online 27 May 2024

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Equitable access to care and management is a priority for patients with epilepsy and may vary depending on each country's healthcare system. As this issue has not been specifically addressed in France, we conducted a retrospective study to identify discriminating factors in access to surgery at a French tertiary epilepsy center. Initially, we examined factors previously identified in other countries as influential in surgery access, including age at diagnosis, affected side, gender, years of education, socio-professional categories, and density of general practitioners in the residential area, in 293 consecutive French-native patients with refractory medial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). Subsequently, we conducted a case-control study comparing patients born in France with 22 patients born abroad to specifically explore migratory status. The analysis revealed that the only three factors statistically influencing the delay between the onset of epilepsy and entry into video-EEG were early age at onset (associated with a longer delay), pensioner status (associated with a longer delay), and student status (associated with a shorter delay). Migratory status, gender, and socio-economic level (indirectly reflected by the level of education and socio-professional category) were not found to be discriminatory factors in access to video-EEG. Discrepancies between our study and foreign studies may be attributed to differences in healthcare systems and medical coverage among countries. Efforts in France to improve access to surgery should focus on enhancing communication among practitioners to promptly refer any MTLE-HS patient to an epilepsy surgery center, regardless of their age.

Section snippetsAbbreviationsParticipants

We conducted a comprehensive study involving 322 consecutive patients with medically intractable MTLE-HS who were potential candidates for surgery. All individuals underwent assessment as part of a pre-surgical investigation at the Epilepsy Unit of Pitié-Salpêtrière Hospital in Paris between 1993 and 2019. The inclusion criteria comprised: i) video-EEG recording; ii) magnetic resonance imaging confirmation of hippocampal sclerosis; and iii) complete neuropsychological assessment.

Ethical

Factors influencing delay between onset of epilepsy and pre-surgical video-EEG in French-native MTLE-HS patients

We identified 300 MTLE-HS patients born in France patients who underwent assessment as part of a pre-surgical investigation at the Epilepsy Unit of Pitié-Salpêtrière Hospital in Paris between 1993 and 2019. Data was complete for 293 of them. Fifty-eight percent were female patients. The median age at onset of epilepsy was 11.0 [Q1;Q3: 6.0; 17.0] years, while median age at video-EEG was 36.0 [28.0; 46.0] years. One hundred fifty-eight patients (53.9%) had a left-sided epileptogenic focus. The

Discussion

Our findings indicate that neither migratory status, gender, nor socio-economic level (indirectly reflected by the level of education and SPC) of MTLE-HS patients affected the delay between the onset of epilepsy and entry into video-EEG for pre-surgical assessment in a tertiary epilepsy center in France. The only two factors influencing this delay were: i) age at epilepsy onset, with an earlier age at onset associated with a longer delay; and ii) age at evaluation, where pensioner status was

Conclusion

A recent study emphasized that equitable healthcare should be a priority in neurological care [24]. The majority of studies addressing inequality parameters in access to surgery are predominantly from American research. It is crucial to replicate these studies in other countries to establish a comprehensive understanding of these disparities and formulate targeted solutions. The present French study, conducted with 322 MTLE-HS patients, demonstrates that in a French tertiary epilepsy center,

Disclosure of interest

VN received speaker Honoria from UCB, Jazz, Nutricia, EISAI; received consultation fees for advising from UCB, Angelini, Jazz; SD received speaker Honoria from Angelini, Bial, EISAI, Sanofi-Genzyme; received consultation fees for advising from Angelini, Jazz, EISAI.

The other authors declare that they have no competing interest.

Informed consent

All patients included in the study gave retrospective consent to participate.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Ethical statement

Ethical approval for this study was obtained from the medical ethical committee of Sorbonne-Université (CER-2023-EpiRAGE).

Author contributions

Conceptualization: MH, SD. Acquisition of data: TB. Statistical analysis: MH. Writing original draft preparation: SD. Writing, review and editing: TB, MH, VN, BH, SD.

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