Long-term outcomes of pediatric epilepsy surgery: Individual participant data and study level meta-analyses

Harris, Wesley R.; Brunette‐Clément, Tristan; Wang, Andrew; Phillips, H. Westley; Weil, Alexander G.; Fallah, Aria

doi:10.1016/j.seizure.2022.08.010

Cited by 11 publications

(14 citation statements)

References 43 publications

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“…is likely due to our cohort including only HME, whereas their cohort included other malformations of cortical development, which traditionally respond better to surgery than HME. In addition, our cohort's lower seizure freedom might be explained by a long inclusion period of over 30 years, compared to more recent collection periods where advancements in modern technology and surgical technique were available, where seizure outcomes were improved 18 …”

Section: Discussionmentioning

confidence: 94%

Hemispheric epilepsy surgery for hemimegalencephaly: The UCLA experience

Goel,

Phillips,

Chen

et al. 2023

Epilepsia

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ObjectivesHemimegalencephaly (HME) is a rare congenital brain malformation predominantly presenting with drug‐resistant epilepsy. Hemispheric disconnective surgery is the mainstay of treatment, however, little is known about how postoperative outcomes compare across techniques. Thus, we present the largest single‐center cohort of patients with HME who underwent epilepsy surgery and characterize outcomes.MethodsThis observational study included patients with HME at UCLA from 1984‐2021. Patients were stratified by surgical intervention: anatomic hemispherectomy (AH), functional hemispherectomy (FH) or less‐than‐hemispheric resection (LTH). Seizure‐freedom, functional outcomes, and operative complications were compared across surgical approaches. Regression analysis identified clinical and intraoperative variables that predict seizure outcomes.ResultsOf 56 patients, 43 (77%) underwent FH, 8 (14%) underwent AH, 2 (4%) underwent LTH, 1 (2%) underwent unknown hemispherectomy type, and 2 (4%) were managed non‐operatively. At median last follow‐up of 55 (IQR:20‐92) months, 24 (49%) patients were seizure‐free, 17 (30%) required CSF‐shunting for hydrocephalus, 9/43 (21%) had severe developmental delay, 8/38 (21%) were non‐verbal, and 15/38 (39%) were non‐ambulatory. There was 1 (2%) intraoperative mortality due to exsanguination earlier in this cohort. Of 12 (29%) requiring revision surgery, 6 (50%) were seizure‐free postoperatively. AH, compared to FH, was not associated with improved seizure freedom (HR=0.48, p=0.328) and initial AH trended towards greater odds of seizure freedom (75% vs 46%, p=0.272). Younger age at onset (HR=0.29, p=0.029), lack of epilepsia continua partialis (EPC) (HR=0.30, p=0.022), and no contralateral seizures on EEG (HR=0.33, p=0.039) independently predicted longer duration of seizure‐freedom.SignificanceThis study helps inform physicians and parents of children undergoing surgery for HME by demonstrating that earlier age at seizure onset, absence of EPC and no contralateral EEG seizures were associated with longer postoperative seizure‐freedom. At our center, initial AH for HME may provide greater odds of seizure freedom with comparable complications and functional outcomes to FH.

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Section: Discussionmentioning

confidence: 94%

Hemispheric epilepsy surgery for hemimegalencephaly: The UCLA experience

Goel,

Phillips,

Chen

et al. 2023

Epilepsia

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“…1,2,16,17 The apparent waning postoperative effect seen in epilepsy surgery has also been observed across epilepsy surgical techniques, as demonstrated by the meta-analyses performed by Widjaja et al and Harris et al in 2020 and 2022, respectively; they demonstrated a decrease in rates of seizure freedom over time in patients undergoing a wide range of open-resective epilepsy surgery. 18,19 These outcomes illustrate lower rates of meaningful atonic seizure reduction in CCA compared to the long-term durability of patients undergoing CC. For instance, in a single-institution retrospective study on long-term seizure outcomes after CC, Tanriverdi et al demonstrated 77% atonic seizure T A B L E 4 Residual CCA white matter ablation.…”

Section: Discussionmentioning

confidence: 97%

Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study

Phillips,

Hect,

Harford

et al. 2023

Epilepsia Open

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ObjectiveCorpus Callosotomy (CC) is an important treatment for atonic seizures in patients with generalized or multi‐focal drug‐resistant epilepsy (DRE). Traditionally, CC is performed via an open microsurgical approach, but more recently, MR‐guided stereotactic laser interstitial thermal therapy (LITT) corpus callosum ablation (CCA) has been developed to leverage the safety and minimally invasive nature of LITT. Given the recent adoption of CCA at select centers, how CCA compares to CC is unknown. We aim to compare clinical seizure outcomes of CCA to CC after extended follow‐up.MethodsWe performed a retrospective cohort study to compare the effectiveness and safety of CC to CCA from 1994‐2022. The primary outcome was the difference between 50% reduction of target seizure. Secondary outcome measures were postoperative length of stay, adverse events, and other effectiveness metrics. Comparative statistics were executed using Stata. Normality for continuous variables were assessed and parametric statistics were utilized as needed. Frequency was compared with chi‐squared or Fischer's exact tests, when applicable.ResultsData from 47 operations performed on 36 patients were included in this study, of which 13 (36%) patients underwent 17 CCA. Patients who received CCA had similar rates of meaningful reduction (>50%) of atonic seizures as their CC counterparts (55% vs 70% p=0.15). Patients undergoing CCA had significantly shorter hospitalizations than those receiving CC (2.5 vs 6.0 days p<0.001). There was no significant difference in rates of post‐operative complications between the groups, although the magnitude of the complication rates was lower in the CCA cohort (12% vs 28%).SignificanceThis early experience suggests CCA has similar outcomes to traditional CC, albeit with shorter hospital length of stay. However, future studies are necessary to investigate non‐inferiority between these two approaches. Large multi‐center studies are necessary to investigate differences in adverse events and whether these findings generalize across other centers.

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“…In turn, lobectomy (OR 0.280, 95% CI 0.117-0.651, p = 0.003) was associated with decreased long-term seizure freedom (41.9%) compared to lesionectomy (75.7%) and hemispherectomy (69.4%), which achieved similar results (respectively OR 2.184, 95% CI 0.938-5.458, p = 0.079, and OR 1.493, 95% CI 0.691-3.299, p = 0.313). years, 63.7% (95% CI 55.4-71.2) at 5 years, and 61.2% (95% CI 52.5-69.3) ≥ 10 years of follow-up [3].…”

Section: Surgical Treatmentmentioning

confidence: 94%

“…The general predictors of seizure freedom include greater extent of resection, neoplastic etiology, lesional epilepsy, and complete resection of epileptiform foci, in addition to age at surgery [3,23]. Structural MRI remains the mainstay of presurgical evaluation, while positron emission tomography (PET), ictal single photon emission computed tomography (SPECT) and functional MRI (fMRI) approaches provide additional information for localizing the epileptogenic region [25].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

“…Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases [2]. Regarding the pediatric population, epilepsy is one of the most common neurological disorders, affecting up to 0.5% of children [3]. During the first ten years of life, one in every 150 children is diagnosed with this syndrome, which predominates in childhood.…”

Section: Introductionmentioning

confidence: 99%

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Epilepsy in childhood: an update on management

Costa¹,

Silva²,

Thomazin³

et al. 2023

Arch Pediat Neurosurg

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Background: The aim of this study was to review current database for the management of childhood epilepsy, presenting and comparing the different types of treatment, focusing[1] on the ones with the best efficacy. Original articles related to the subject were obtained from SciELO, PubMed and BVS database using descriptors from “Health Sciences Descriptors”. Results: Epilepsy is characterized as a neurological disease that occurs due to abnormal neuronal discharges in the cerebral cortex. It affects 0.5% to 1% of children and is the most frequent chronic neurologic condition in childhood. Anti-epileptic drugs (AEDs) are the most used treatment for epilepsy. Non farmacological options, such as epilepsy surgery and neurostimulation therapy can be used to treat refractory or drug-resistant seizures. Conclusions: Around 70% of individuals with active epilepsy can become seizure-free and go into long-term remission shortly after starting drug treatment with antiepileptic drug in monotherapy. Randomized controlled trials comparing surgery and combinations of AEDs suggest that surgery can be more effective in stopping seizures in children.

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Long-term outcomes of pediatric epilepsy surgery: Individual participant data and study level meta-analyses

Cited by 11 publications

References 43 publications

Hemispheric epilepsy surgery for hemimegalencephaly: The UCLA experience

Hemispheric epilepsy surgery for hemimegalencephaly: The UCLA experience

Comparison of magnetic resonance‐guided laser interstitial thermal therapy corpus callosum ablation to open microsurgical corpus callosotomy: A single‐center retrospective cohort study

Epilepsy in childhood: an update on management

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