Over three decades, pediatric epilepsy surgical volume increased, surgery shifted towards older patients, with reduced extensive resection and reduced reliance on invasive monitoring, and seizure freedom rates remained stable, with improved near-complete seizure control in the later era.
Abstract
INTRODUCTION
Epilepsy is a common pediatric neurologic disorder, and its surgical management has increased over time. To characterize longitudinal changes in patient selection, surgical approach and outcomes, we report a 30-year retrospective review at a high-volume level 4 epilepsy center.
Methods
Consecutive epilepsy surgeries from 1989 to 2018 were analyzed and grouped into early (1989-2003) and late (2004-2018) 15-year eras. Demographic, clinical, radiographic, surgical, and 2-year Engel outcome data were collected and analyzed. Multivariable logistic regression assessed independent associations between era, patient characteristics, imaging findings, surgical procedures, and seizure outcomes.
Results
Of 1241 surgical records, 1128 pediatric cases were included (415 early, 713 late; 55.50% male). Patients in the late era were older at surgery (10.27 vs. 8.53 years, p < .001), and repeat surgery was more common (p < .001). Focal (OR 1.72, p = .005) and cerebral insult related (OR 2.74, p < .001) MRI abnormalities were more frequently treated in the late era. Hemispherectomies, lobectomies and corpus callosotomies were performed less often (all p ≤ .001), while focal and multilobar resections remained stable (p > .05). Use of invasive monitoring and electrical stimulation mapping declined over time (p < .001). Seizure freedom rates were stable, however, ≥ 90% seizure reduction was more common in the late era (OR 1.60, p = .038).
Conclusion
Over three decades, pediatric epilepsy surgical volume increased, surgery shifted towards older patients, with reduced extensive resection and reduced reliance on invasive monitoring. Despite these changes, seizure freedom rates remained stable, with improved near-complete seizure control in the later era.
The goal was to analyze the outcomes of patients undergoing epilepsy surgery at the authors' center, with a minimum follow-up of 15 years, and found Appropriate referral to a refractory epilepsy center permits a multidisciplinary approach that can result in long-term seizure freedom for most patients undergoing surgery.
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
It is suggested that establishing routine FLE services in countries with limited resources is feasible, and a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.
Zainal Muttaqin, J. Bunyamin, Novanda Rizky Radityatama et al.· Surgical neurology internati...· 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
OBJECTIVE
To quantify healthcare resource use before and after epilepsy surgery among pediatric patients with drug-resistant epilepsy, stratifying by type of surgery, type of insurance, race, and ethnicity.
METHODS
Retrospective descriptive study of the Pediatric Health Information System (PHIS) database in the period 2004-2024. Our main outcome was healthcare resource use.
RESULTS
1288 patients (median (p25-p75) age at first epilepsy surgery: 11.0 (6.8-15.3) years, 43% females) had a total of 1538 epilepsy surgeries. Although the median (p25-p75) cost of epilepsy surgery was high [$88,512 ($51,283-$145,159)], after epilepsy surgery (versus before epilepsy surgery) there was a decrease in number of hospital admissions per person-year [0.6 (0.2-1.3) versus 1.4 (0.8-2.4), p < 0.0001], days of hospital stay per person-year [1.5 (0.3-5.0) versus 4.4 (2.2-9.1), p < 0.0001], and total healthcare resource use per person-year [$15,571 ($4,465-$44,089) versus $28,100 ($14,723-$58,455), p < 0.0001]. Decreases in healthcare resource use were more pronounced among patients who required only one epilepsy surgery than in patients who needed subsequent epilepsy surgeries. Decreases in healthcare resource use were similar for all types of surgeries except when the first surgery was laser interstitial thermal therapy (LITT) or ablation or radiosurgery (mainly because many of these patients required subsequent surgeries), for all types of insurances, for all races, and for all ethnicities.
CONCLUSION
Among pediatric patients with drug-resistant epilepsy, healthcare resource use substantially decreases after epilepsy surgery, especially when the patient does not require subsequent epilepsy surgeries. Results were similar for all types of insurance, for all races, and for all ethnicities.
Alex S. Aguirre, Daan A Pijs, I. Sánchez Fernández· Epilepsy Research· 0 citations
Background.
Epilepsy onset occurs in childhood in 70% of patients and is considered a major problem in pediatric neurology.
Objective:
To study the profile of inpatients aged 1 month to 3 years with newly diagnosed epilepsy.
Material and methods.
A retrospective analysis of 261 medical records of children with a newly diagnosed epilepsy admitted to the Early Childhood Psychoneurology Department No. 1 of the Children's Center for Psychoneurology and Epileptology at the Republican Children's Clinical Hospital (Ufa) between 2018 and 2024 was conducted. Patients ranged in age from 1 month to 3 years. The average age of patients was 8,7±0,7 months, with a predominance of boys (56,3%). All patients underwent clinical, instrumental, laboratory, neuroimaging, and electrophysiological (electroencephalography (EEG), video-EEG monitoring) examinations.
Results.
The rate of all cases of epilepsy peaked in children under 1 year of age – 206 (79%). West syndrome and Ohtahara syndrome were noted in 62 (23,7%) children aged 7 to 12 months. Depending on the etiology, structural epilepsy was observed in 197 (75,5%) patients. The most common cause of epilepsy with an established etiologic factor was hypoxic-ischemic, hemorrhagic lesion of the central nervous system – 159 (61%). In young children, a frequent combination of epileptic seizures with delayed psychomotor and psychospeech development was recorded (83,9%). In 23,7% of patients, hypsarrhythmia, “burst-suppression” – a pattern specific to epileptic encephalopathies (West and Ohtahara syndromes) were EEG recorded. Valproic acid was the drug of choice when prescribing anticonvulsant therapy. Serum antiepileptic drug levels remained adequate throughout treatment.
Conclusion.
The results of our study highlight the importance of a comprehensive approach to epilepsy treatment. Early diagnosis, comprehensive treatment with appropriate antiepileptic drug selection based on seizure type and epilepsy etiology, and rehabilitation improve prognosis and quality of life for children with epilepsy. Further research is needed to gain insights into genetic and environmental risk factors and to develop new methods for prevention and treatment of epilepsy in young children.
L. B. Novikova, K. M. Ziultsle, A. Akopyan et al.· Epilepsy and paroxysmal cond...· 0 citations
