Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

Abstract

Objective To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. Methods We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. Results We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P < .0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend = .0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend = .0047) and a significant decrease in unilobar temporal surgeries (P for trend = .0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo‐electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. Significance Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures.

Trends in pediatric epilepsy surgery: A lower‐middle‐income country perspective

“…Partial lobectomies and lobectomies were the commonest surgeries conducted followed by hemispherotomy. In a recent study done across 20 centers in 10 European countries, a significant increase in the number of pediatric epilepsy surgeries was noted between 2008 and 2015 14 . A significant increase in extratemporal surgeries was noted in this study with a simultaneous decrease in the number of temporal surgeries.…”

“…The increasing number of pediatric epilepsy surgeries seen over the years in this study mirrors trends in other countries and selected important studies on trends in surgeries across countries/continents are given in Table 4 13,14,21,22 . Knight et al reported that the rates of pediatric epilepsy surgery in the United States increased significantly, from 0.85 epilepsy surgeries per 1000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1000 children with epilepsy in 2009.…”

“…However, studies from various countries have reported a decreasing trend in adult epilepsy surgeries of late 11,12 . Trends in pediatric epilepsy surgery are still emerging, and some studies have shown an increasing number of surgeries in this age group 13,14 . Low‐ and middle‐income countries (LMICs) bear a disproportionally high burden of epilepsy, 15 but studies on surgical trends from these regions are limited.…”

Microelectrode recordings in human epilepsy: a case for clinical translation

“…Sixty-five years after single units were first recorded in the human brain; there remain no established clinical indications for microelectrode recordings in the presurgical evaluation of patients with epilepsy ( Cash and Hochberg, 2015 ). This is contrasted by multiple studies that have demonstrated that, despite the increased use of intracranial electrophysiology in presurgical evaluation, seizure freedom outcomes following epilepsy surgery have remained largely stable around 70% over the last 20 years ( Baud et al , 2018 ; Barba et al , 2020 ). Therefore, there is a clear need to improve our localization strategies (be that to a specific brain region or network-level change) and we argue that microelectrode recordings have the potential to complement traditional imaging and macroscale electrophysiology by adding an additional layer of data at a different scale that could contribute to improved outcomes.…”

Pediatric epilepsy surgery: Past, present, and future

“…In this issue of Epilepsia , Barba et al add to the growing body of this retrospective literature with a multicenter cohort analysis of 1859 operations in children with drug‐resistant focal epilepsy undergoing surgical resection at 20 centers in 10 European countries. All surgeries were performed between 2008 and 2015, and for purposes of analysis, patients were subdivided into two cohorts of children: aged <7 years and aged 7‐16 years.…”