The findings suggest that referring children for surgery sooner rather than later can meaningfully improve their chances of living seizure‐free and underscore the importance of achieving complete lesion removal to optimize postoperative seizure control.
Abstract
Abstract Objective Epileptic spasms (ES) in children carry a high risk of neurodevelopmental delay, yet predictors of long‐term surgical outcome remain incompletely defined. This study aimed to evaluate seizure outcomes following epilepsy surgery and to identify independent prognostic factors for postoperative recurrence. Methods This retrospective cohort study included 73 patients (47 males, 64%; median age at surgery: 37 months, IQR: 20–55.5) with drug‐resistant ES who underwent resective or ablative surgery at Guangdong Sanjiu Brain Hospital in China between January 2015 and September 2024, with regular follow‐up at least 12 months after epilepsy surgery. Independent predictors of recurrence were identified using multivariate Cox proportional hazards regression, and Kaplan–Meier analysis was performed to compare seizure‐free survival stratified by seizure duration (SD) and residual lesion status. Results Seizure‐free rates were 75.3% at 1 year and 55.1% at last follow‐up. Mean follow‐up was 61.36 ± 26.10 months (range: 12–132). Among malformation of cortical development (MCD) subtypes, focal cortical dysplasia (FCD) type II demonstrated the highest 5‐year seizure‐free rate (100%), whereas mild MCD (m‐MCD) showed the lowest (33.3%; p = 0.039). On multivariate Cox analysis, residual lesion on postoperative MRI was the strongest independent predictor of recurrence (HR = 5.13; 95% CI: 2.28–11.51; p < 0.001), followed by SD exceeding 36 months (HR = 2.49; 95% CI: 1.17–5.29; p = 0.018). Kaplan–Meier analysis confirmed a twofold difference in 5‐year seizure‐free survival between patients with duration ≤36 versus >36 months (73% vs. 36%; log‐rank p = 0.00069), and significantly better seizure‐free survival in patients without residual lesions (log‐rank p < 0.0001). Significance Complete lesion resection and early surgical intervention (SD ≤36 months) are independently associated with favorable long‐term seizure outcomes in children with drug‐resistant ES. Pathological subtype, particularly FCD type II, further refines prognostic stratification. These findings support prompt surgical referral and underscore the importance of achieving complete lesion removal to optimize postoperative seizure control. Plain Language Summary Some children develop a severe form of epilepsy called epileptic spasms that cannot be controlled with medication. In this study of 73 children who had brain surgery for this condition, more than half remained seizure‐free after 5 years. Children who had surgery earlier—before seizures had continued for 3 years—and those in whom the entire abnormal brain tissue was removed did significantly better in the long run. These findings suggest that referring children for surgery sooner rather than later can meaningfully improve their chances of living seizure‐free.
High-frequency IEDs on early postoperative EEG may identify patients at increased risk of long-term deterioration after surgery for HS-related TLE, and prospective studies are needed before modifying routine follow-up strategies.
Kate Durbano, Q. Calonge, Valerio Frazzini et al.· Seizure· 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
OBJECTIVE
Given the reciprocal interaction between tumor biology and seizure activity, seizure outcomes in low-grade glioma (LGG) may be dynamic and influenced by both tumor- and treatment-related factors. We aimed to identify factors associated with seizure occurrence across distinct clinical stages, including diagnosis, surgery, long-term follow-up, and antiseizure medication (ASM) withdrawal.
METHODS
We retrospectively analyzed patients with World Health Organization grade 1-2 glioma who underwent surgery between January 2001 and February 2025 and experienced seizures during their disease course. Clinical, radiological, molecular, and treatment-related variables, along with longitudinal seizure data, were collected. Seizure outcomes were evaluated at 6 and 12 months and at final follow-up, including time to postoperative seizure recurrence and recurrence after ASM withdrawal.
RESULTS
Among 100 patients (mean postoperative follow-up = 89.9 months), 70.0% achieved seizure freedom during the final year of follow-up. At 6 months, gross total resection (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.19-10.01, p = .02) and preoperative tumor volume (OR = .99, 95% CI = .97-1.00, p = .048) were independently associated with seizure outcomes. At 12 months, preoperative tumor volume (OR = .99, 95% CI = .98-1.00, p = .04) was significant. Conversely, seizure at presentation was the sole independent determinant of favorable long-term seizure outcome (OR = 6.37, 95% CI = 2.07-19.61, p < .01) and the only predictor of reduced postoperative seizure recurrence in survival analysis (hazard ratio = .26, 95% CI = .11-.62, p < .01). ASM withdrawal was successful in 67.7%. Although tumor progression showed a trend toward an association with recurrence in univariate analyses, no independent predictors were identified in Cox regression for ASM withdrawal outcomes.
SIGNIFICANCE
This time-resolved analysis suggests that early seizure control is primarily influenced by surgical and tumor burden-related factors, whereas long-term seizure outcomes and recurrence appear to be predominantly determined by the clinical presentation at diagnosis rather than treatment-related variables. These findings suggest that postoperative seizure prognosis in LGG reflects pre-existing epileptogenic vulnerability and may not be adequately captured by single time point assessments.
Kyung-Il Park, Chul-Kee Park, Soon-Tae Lee et al.· Epilepsia· 0 citations
Background/Objectives: Neurological impairment after glioma resection is a common postoperative event, but many deficits improve during recovery. The present study investigated whether transient and persistent postoperative neurological deficits differ in their association with overall survival (OS) and progression-free survival (PFS). Methods: We retrospectively reviewed data from patients who underwent initial surgical treatment for glioma in our institution. Neurological function was evaluated using documented clinical examinations performed before surgery, in the immediate postoperative period, and during routine follow-up 3–6 months after the procedure. Results: The study cohort comprised 496 patients, of whom 44.4% were women. The mean age at surgery was 60 years (95% CI, 58–61), and the average follow-up period was 21 months (95% CI, 19–23). According to the 2021 WHO classification, 80.0% of tumors were grade 4, 11.1% were grade 3, and 7.3% were grade 2. IDH mutations were absent in 81% of cases. Median survival for the entire cohort was 34 months (95% CI, 30–38). Preoperative neurological deficits, including hemiparesis, were not significantly associated with OS. Postoperative deficits that were resolved by the follow-up assessment showed no relationship with either OS or PFS, irrespective of IDH mutation status. In contrast, neurological deficits that persisted at follow-up were independently associated with shorter OS and PFS among patients with IDH-wild-type gliomas (p < 0.001), whereas no significant association was observed in the IDH-mutant subgroup. Similarly, when new neurological deficits were present at follow-up, poorer OS and PFS were predicted only in patients with IDH-wild-type tumors (p < 0.001). Conclusions: Temporary neurological deterioration following glioma surgery does not appear to adversely influence overall or progression-free survival, regardless of IDH status. However, persistent postoperative deficits, as well as newly acquired deficits that remain evident during follow-up, are strong indicators of an unfavorable prognosis in patients with IDH-wild-type gliomas.
J. Klingenschmid, M. Demetz, N. Pichler et al.· Journal of Clinical Medicine· 0 citations
Accurate estimation of seizure recurrence risk after pediatric epilepsy surgery may support individualized postoperative surveillance and management. This study aimed to develop and temporally validate a prognostic nomogram for estimating 1-year and 2-year seizure-free survival after focal or lobar resection in children with drug-resistant epilepsy.
This single-center retrospective cohort study included 256 children treated between 2015 and 2024. Patients treated during 2015–2021 constituted the training cohort (
n
= 181), whereas those treated during 2022–2024 constituted the temporal validation cohort (
n
= 75). Eighteen prespecified clinical, neuroimaging, scalp EEG, surgical, and histopathological candidate predictors were evaluated using least absolute shrinkage and selection operator penalized Cox regression with 10-fold cross-validation. Selected variables were entered into a multivariable Cox proportional hazards model. Internal validation repeated the complete model-development procedure in 1,000 bootstrap resamples. Model performance was assessed using Harrell's C-index, time-dependent area under the curve, calibration, Brier scores, and decision curve analysis.
Five predictors were retained: longer epilepsy duration, absence of a definitive structural MRI lesion, histopathological diagnosis, subtotal resection, and a high non-rapid eye movement interictal spike index (>38 spikes/h). The optimism-corrected C-index was 0.81 in the training cohort, and the C-index was 0.79 in the temporal validation cohort. The 1-year and 2-year time-dependent AUCs were 0.82 and 0.81 in the training cohort and 0.80 and 0.78 in the temporal validation cohort, respectively. Calibration was generally acceptable, and decision curve analysis suggested potential net benefit across the evaluated threshold range.
The nomogram showed useful performance for estimating postoperative seizure-free survival in this single-center cohort. Because histopathological diagnosis and resection completeness are required, the model is intended for early postoperative risk stratification rather than preoperative candidate selection or presurgical counseling. Independent multicenter validation and prospective evaluation of clinical impact are required before routine implementation.
Unknown authors· Frontiers in Pediatrics· 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
