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SUMMARYPurpose: The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care. Methods: Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage.Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care. Results: Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model. Discussion: There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care. KEY WORDS: Epilepsy, Health care utilization, Disparities, Sociodemographics, Race/ethnicity.A number of studies provide evidence that minorities with epilepsy in the United States receive different amounts of health care compared to nonminority whites (see literature reviews by Szaflarski et al., 2006 and Theodore et al., 2006). This is a concern for advocates and policy makers who seek to eliminate inequalities in epilepsy care and improve the health of high-risk populations. However, there are no studies examining the extent to which the disparities can be explained by such factors as differences in individual patient characteristics or variations in provider practices. We are conducting a 1-year longitudinal study of epilepsy care at four sites, two in Houston and two in Answers to such questions are needed to help inform program administrators, providers, and policy makers of the underlying reasons for disparities so that effective strategies might be designed to reduce or eliminate them.This report describes the methods used to conduct the study and provides preliminary results based on initial baseline data from the patient sample.

Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is usually refractory to medical management. When medications fail, alternative therapies are considered. Among these are two surgical options: corpus callosotomy and vagus nerve stimulation (VNS). Safety and efficacy are two important factors to consider when selecting an appropriate treatment. VNS is safer than callosotomy, but its efficacy is more difficult to assess. Available studies evaluate its effectiveness using a mixed population of patients (some with prior epilepsy surgery), a multitude of VNS settings, and variable endpoints. To estimate the efficacy of VNS in patients with LGS, a review of the medical literature and the VNS Patient Registry was performed. Within the limits of this type of study, the results showed that VNS appears equally as effective as callosotomy. Because VNS has a lower potential for adverse events, these results suggest that VNS should be considered first in appropriately selected patient.