Abstracts

Rationale: Epilepsy surgery is an underutilized resource for children with pharmacoresistant epilepsy. Both palliative and definitive surgical options can reduce seizure burden and improve quality of life for affected children and caregivers. Palliative epilepsy surgery is often seen as a “last resort” compared to definitive surgical options. We compare patient characteristics and postsurgical outcomes between palliative and definitive epilepsy surgical candidates from the PERC surgical database.

Methods: The PERC Epilepsy Surgery database is a prospective study enrolling patients 0-18 years of age undergoing evaluation for epilepsy surgery at 20 pediatric epilepsy centers. We included all children with completed surgical therapy characterized as definitive (intended to achieve seizure freedom) or palliative. Demographics, epilepsy type, age of onset, age at referral, etiology of epilepsy, treatment history, time-to-referral/evaluation, number of failed antiseizure medications (ASM) imaging results, type of surgery completed, and post-operative outcome were acquired.

Results: Four hundred and two children completed epilepsy surgery were identified. We analyzed three hundred and nineteen with complete data sets. Baseline patient characteristics are presented in table 1a and 1b. Definitive procedures were performed in 215 (67%) in comparison with 104 (33%) who underwent palliative surgery. The age of seizure onset and type of first seizure (focal onset) were similar between the two groups. Most patients had abnormal MRI results (74.4% and 88.4%). Following surgery, 160 patients in the definitive group (74.4%) achieved seizure freedom at follow-up appointments (median 6 months, range 3-38 months), whereas 29.8% achieved seizure freedom in the palliative group. 46% of palliative patients received neuromodulation and 15% received corpus callosotomy. Patients receiving definitive surgery were referred for surgery at younger age than those receiving palliative surgery (median 9.5 (IQR 4.8-14.5) vs 10.7 (IQR 5.6-14.6) yrs). For children receiving palliative surgery, time from second ASM failure to surgery was longer (median 2 [IQR0.3-4.5] vs 0.4 [IQR0-2], p < 0.0001), and more ASM had been trialed (4 [IQR2-5] vs 3 [IQR1-4], p < 0.0001). After surgery, children who underwent palliative procedures were less likely to be seizure free (30% vs 74.4%, p < 0.0001) and less likely to have an >50% seizure reduction (70% vs 92.8%, p < 0.0001). When comparing surgical outcome and type of surgery completed in a multivariable regression model with surgical intent, MRI result, number of failed ASM, amount of follow-up, time to referral and ASM failure analyzed, no statistically significant variables were identified to explain variance in surgical efficacy.

Conclusions: As expected, outcomes are better for definitive surgery compared to palliative. However, seizure reduction of >50% is achieved for most children that underwent palliative procedures, similar or better than the response seen with additional ASM trials. This suggests earlier referral and consideration of palliative surgical treatment is warranted.

Funding: Please list any funding that was received in support of this abstract.: unfunded.