Variability in recommending epilepsy surgery across Level IV epilepsy centers in the United States.

Delayed Surgical Evaluation After Drug-Resistant Epilepsy Diagnosis Worsens Outcomes in Children: A Multicenter Study.

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.

Epilepsy Surgery vs Medical Management for Pediatric Drug-Resistant Focal Epilepsy

Predicting pediatric epilepsy surgery outcomes via a multidisciplinary epilepsy surgery conference survey.

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.

Effect of time to palliative epilepsy surgery on outcomes.

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.

Impact of pediatric epilepsy surgery on healthcare resource use.

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.

Socioeconomic status and epilepsy surgery in the United States: Timing and outcomes.

OBJECTIVE Epilepsy surgery offers curative potential for refractory focal epilepsy, yet it remains underutilized, particularly among socioeconomically disadvantaged populations. In this study, we aim to explore the impact of socioeconomic status on timing and subsequently on outcomes of epilepsy surgery. METHODS This retrospective longitudinal cohort study analyzed 1027 patients who underwent epilepsy surgery at the Cleveland Clinic between 1997 and 2023, using the Area Deprivation Index to assess neighborhood-level socioeconomic status. RESULTS Findings revealed significant delays to surgery and worse baseline mental and physical health among patients from quintiles with lower neighborhood resources. Despite these disparities, seizure freedom (Engel class I) and postoperative improvements in quality of life and mental health were comparable across all socioeconomic strata. SIGNIFICANCE These results underscore the need for equitable access to epilepsy surgery and suggest that socioeconomic status should not delay or deter surgical referral, as outcomes remain robust across diverse populations. We also demonstrate that patients enter surgery on distinct health trajectories shaped by socioeconomic disadvantage, highlighting the need for early identification and intervention to maximize postoperative benefit.