Effect of time to palliative epilepsy surgery on outcomes
Abstract
Abstract 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.
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Authors: Robert M. Crutcher, David Horvat, Avery R. Caraway, Kristen H. Arredondo, Taylor J. Abel, Nitin Agarwal, Allyson Alexander, Dallas Armstrong, Kurtis I. Auguste, Danilo Bernardo, Jeffrey Bolton, David Bonda, Dewi F. Depositario‐Cabacar, Krista Eschbach, William D. Gaillard, Aran Groves, Jason S. Hauptman, Pradeep Javarayee, Cemal Karakas, Andrew Knox, Jenny Lin, Patricia E. McGoldrick, D. Miller, Edward J. Novotny, Adam P. Ostendorf, Pilar Pichon, Shilpa B. Reddy, Debopam Samanta, Rani K. Singh, Janelle L. Wagner, Steven M. Wolf, Lily C. Wong‐Kisiel, Fernando Galán, Μ. Scott Perry, Michael A. Ciliberto
Institutions: University of Pittsburgh, University of Colorado Denver, University of Arkansas for Medical Sciences, Harvard University, Nationwide Children's Hospital, Phoenix Children's Hospital, Children's Healthcare of Atlanta, University of California, San Francisco, University of Iowa, Cedars-Sinai Medical Center, The University of Texas at Austin, University of Wisconsin–Madison, The University of Texas Southwestern Medical Center, George Washington University Hospital, Children's National, Mayo Clinic, Medical University of South Carolina, Children's Hospital of Orange County, Boston Children's Hospital, Alexander T. Augusta Military Medical Center, Cook Children's Medical Center, Minnesota Epilepsy Group, Children's Hospital Colorado, UCSF Benioff Children's Hospital, Doernbecher Children's Hospital, Medical College of Wisconsin, Mount Sinai Beth Israel, St. Luke's-Roosevelt Hospital Center, Brentwood Hospital, Seattle Children's Hospital, Monroe Carell Jr. Children's Hospital, University of Arkansas Medical Center, Levine Children's Hospital