There is a paucity of data assessing the accuracy of clinician prognostication for pediatric epilepsy surgery outcomes during multidisciplinary epilepsy surgery conferences (ESCs). This cross-sectional study, completed at Children's Hospital of Colorado (CHCO) and Children's Health Dallas (CHD), compared seizure freedom predictions by the ESC panels (captured via anonymous surveys of ESC members) to estimated outcomes by the Seizure Freedom Score (SFS) and to observed post-operative seizure freedom rates. The sample comprised 20 patients from CHCO (12/2021 - 12/2022) and 10 patients from CHD (6/2022-12/2023) satisfying inclusion criteria of at least 9 months of follow-up and survey completion by ≥ 50% of the ESC panels. Six patients were excluded from ESC prediction analysis for lack of consensus in their predicted prognoses. Predicted seizure freedom probabilities were assigned in ranges. The ESC panels accurately predicted seizure freedom for 80% (n = 8/10) of children for whom they had assigned higher predictive probabilities. Most of these children had known lesions and concordant presurgical data. ESC physicians accurately predicted lack of seizure freedom for 75% (n = 3/4) of children for whom they assigned lower predictive probabilities for seizure freedom. However, for the intermediate probabilities of 50-69%, 27% (n = 3/11) of children achieved seizure freedom. The SFS (scores 3-4) accurately predicted seizure freedom for 69% (n = 9/13) of patients. The ESC panels were most accurate in predicting seizure freedom at the extremes of the predicted probability spectrum and performed similarly to the SFS.
Purva R. Choudhari, Katherine Bonds, K. Eschbach et al.· Epilepsy Research· 0 citations
OBJECTIVE
Epilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery; however, an analogous effect in palliative procedures has not been shown. We reviewed the Pediatric Epilepsy Surgery Database data for an association between epilepsy duration and seizure reduction in palliative procedures.
METHODS
Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered at 6-12 months and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure.
RESULTS
A total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures.
SIGNIFICANCE
We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.
Robert M Crutcher, David E. Horvat, A. Caraway et al.· Epilepsia· 0 citations
Similar children evaluated at different institutions had significant differences in the odds of not being recommended surgery, suggesting that institutional decision-making contributes importantly to surgical candidacy.
A. Caraway, Nancy A Mcnamara, Andrew T. Knox et al.· Epilepsia· 0 citations
Delays from DRE diagnosis were independently associated with reduced seizure freedom, supporting presurgical evaluation within 1 year as an evidence-based quality benchmark, and DRE-to-evaluation interval, not total epilepsy duration, predicted outcomes.
Debopam Samanta, A. Caraway, Andrew T. Knox et al.· Neurology Clinical Practice· 0 citations
This review synthesizes advances in neuroimmunology, clinical phenotyping, diagnostics, immunomodulatory and antiseizure therapies, neuromodulation, and patient and family centered outcomes, and outlines future directions focused on biomarker-driven precision medicine, disease-modifying strategies, and interdisciplinary care models.
Alica M. Goldman, Nora Wong, A. Vezzani et al.· Epilepsy Currents· 0 citations