There is substantial variability in outcomes following invasive monitoring and surgical treatment of drug‐resistant epilepsy (DRE). Patients with DRE are uniquely vulnerable to cross‐national health care disparities, as their epilepsy is difficult to treat and requires extensive resources. In a large cross‐national database of patients undergoing invasive monitoring for epilepsy surgery, we sought to evaluate the association between social, economic, and educational indicators of the country of treatment and patient outcomes following invasive monitoring. We performed a mixed‐effects analysis of an individual patient database of 595 subjects enrolled in 33 studies encompassing 25 neurosurgical centers in 10 countries of invasive monitoring for epilepsy from 1996 to 2019. Upon preliminary univariate analysis, significant nation‐level predictors of seizure outcome following either stereoelectroencephalography or subdural electrodes were hospital beds per 100,000 population, physician density, gross domestic product (GDP) growth, male and female educational attainment, and unemployment rate. On multivariate mixed‐effects logistic regression, physician density (β = −0.5112, P<.00697) and GDP growth (β = 0.53822, P<.00404) were the only nation‐level covariates of significance associated with seizure outcome. A higher physician density was associated with lesser seizure freedom rates, whereas higher GDP growth was associated with greater seizure freedom rates. Although patient‐specific variables were the primary determinant of seizure outcomes, cross‐national disparities also contribute to heterogeneities. Our findings highlight the importance of a systems‐level dialogue to improve surgical outcomes for DRE patients.

中文翻译：

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跨国差异导致有创监测后患者结果的异质性：分层混合效应分析

在耐药性癫痫 (DRE) 的侵入性监测和手术治疗后，结果存在很大差异。DRE 患者特别容易受到跨国医疗保健差异的影响，因为他们的癫痫难以治疗并且需要大量资源。在接受癫痫手术侵入性监测的患者的大型跨国数据库中，我们试图评估治疗国的社会、经济和教育指标与侵入性监测后患者结果之间的关联。我们对 1996 年至 2019 年间在 10 个国家的 25 个神经外科中心开展的 33 项研究纳入的 595 名受试者的个体患者数据库进行了混合效应分析。根据初步单变量分析，立体脑电图或硬膜下电极后癫痫发作结果的重要国家级预测因素是每 100,000 人的病床数、医生密度、国内生产总值 (GDP) 增长、男性和女性受教育程度以及失业率。在多元混合效应逻辑回归中，医生密度（β = -0.5112，P<.00697）和 GDP 增长（β = 0.53822，P<.00404）是唯一与癫痫结果相关的国家级协变量。较高的医生密度与较低的无癫痫发作率相关，而较高的 GDP 增长与较高的无癫痫发作率相关。尽管患者特定变量是癫痫发作结果的主要决定因素，但跨国差异也会导致异质性。