Objective:

To compare 20-year trends in resection and neurostimulator use among patients with refractory epilepsy (RE) in the United States.

Background:

Surgical resection (SR) and neurostimulator placement (NP) remain key treatments for RE. Despite these advances including antiseizure medications (ASM), recent racial/ethnic trends in epilepsy care are poorly defined.

Design/Methods:

Retrospective analyses were conducted using the TriNetX US Collaborative Network, encompassing 71 healthcare organizations (2005 - 2025) and patients aged 18 - 80. Two periods were compared: 2005–2015 and 2015–2025. Primary endpoints were SR (CPT 1009097) and NP (CPT 1009263). Cohorts included Asian, Black, Hispanic, Native American (NA), and Non-Hispanic White (NHW) patients. Risk ratios (RRs) were calculated between racial/ethnic groups using NHW as reference, matched for age, sex, and ASM use.

Results:

Among 1,327,254 RE patients, SR and NP rates were 1.5% and 1.7%, respectively. From 2005 - 2015 to 2015 - 2025, SR declined from 1.8% to 1.2% (RR 0.51, p < 0.0001), and NP from 1.8% to 1.5% (RR 0.83, p < 0.0001). Across 20 years, NHW patients had higher SR and NP rates than Black (1.7% vs 1.1%; 1.9% vs 1.2%) and NA patients (1.7% vs 0.8%; 1.9% vs 1.0%), all p < 0.0001. Differences between NHW and Hispanic patients were insignificant for SR (1.55% vs 1.52%; RR 0.98, p = 0.54) and NP (1.7% vs 1.7%; RR 0.99, p = 0.76). Asian patients showed higher SR (1.6% vs 2.0%; RR 1.21, p < 0.001) and NP (1.7% vs 2.1%; RR 0.82, p = 0.002) rates compared with NHW. Intra-racial analyses revealed declining procedural rates in all but Asian patients.

Conclusions: