Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood

Amy Ka; Amir Taher; Stephanie D'Souza; Elizabeth H. Barnes; Sachin Gupta; Christopher Troedson; Fiona Wade; Olga Teo; Russell C. Dale; Chong Wong; Andrew F. Bleasel; Mark Dexter; Kavitha Kothur; Deepak Gill

Epilepsy & Behavior Reports (Jan 2022)

Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood

Amy Ka,
Amir Taher,
Stephanie D'Souza,
Elizabeth H. Barnes,
Sachin Gupta,
Christopher Troedson,
Fiona Wade,
Olga Teo,
Russell C. Dale,
Chong Wong,
Andrew F. Bleasel,
Mark Dexter,
Kavitha Kothur,
Deepak Gill

Affiliations

Amy Ka: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
Amir Taher: University of Sydney, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia
Stephanie D'Souza: University of Sydney, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia
Elizabeth H. Barnes: NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney
Sachin Gupta: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
Christopher Troedson: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
Fiona Wade: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
Olga Teo: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
Russell C. Dale: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; University of Sydney, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia; Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
Chong Wong: Department of Neurology, Westmead Hospital, Westmead, Sydney, Australia
Andrew F. Bleasel: Department of Neurology, Westmead Hospital, Westmead, Sydney, Australia
Mark Dexter: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Neurology, Westmead Hospital, Westmead, Sydney, Australia
Kavitha Kothur: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; University of Sydney, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia; Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
Deepak Gill: TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; University of Sydney, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia; Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia; Corresponding author at: TY Nelson Department of Neurology, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.

Journal volume & issue: Vol. 19
p. 100561

Abstract

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There is a paucity of data on longitudinal seizure outcome of children undergoing epilepsy surgery. All children (n = 132) who underwent resective epilepsy surgery from January 1998 to December 2015 were identified. Relevant clinical, neurophysiological, imaging, surgical and seizure outcome data were extracted. Multivariable logistic regression analysis and Kaplan-Meier survival with Cox proportional hazard modelling were performed. The mean age at surgery was 7.8 years (range 0.2–17.9). 71% were seizure-free at a mean follow up of 5.3 ± 2.7 years. Of those who were seizure-free, 65 patients were able to completely wean off anti- seizure medications successfully. Using survival analysis, the probability of Engel Class I outcome at one year after surgery was 81% (95% confidence interval [CI] 87%–75%). This dropped to 73% at two years (95% CI 81%–65%), 58% at five years (95% CI 67.8%–48%), and 47% at ten years. Proportional hazard modelling showed that the presence of moderate to severe developmental disability (HR 6.5; p = 0.02) and lack of complete resection (HR 0.4; p = 0.02) maintain association as negative predictors of seizure-free outcome. Our study demonstrates favorable long-term seizure control following pediatric epilepsy surgery and highlights important predictors of seizure outcome guiding case selection and counseling of expectations prior to surgery.

Published in Epilepsy & Behavior Reports

ISSN: 2589-9864 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system; Science: Physiology: Neurophysiology and neuropsychology
Website: https://www.journals.elsevier.com/epilepsy-and-behavior-reports

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