Comparison of Corpus Callosotomy vs Focal Surgery for Semiologically-Identified Generalized Tonic Seizures in Pediatric Drug-Resistant Epilepsy: Findings from the PERC Epilepsy Surgery Subgroup
Abstract number :
2.322
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
552
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Cemal Karakas, MD – University of Louisville
Juliet Knowles, MD, PhD – Stanford University; Aaron Warren, PhD – Brigham and Women’s Hospital, Harvard School of Medicine; Scott Perry, MD – Cook Children's Medical Center; Lily Wong-Kisiel, MD – Mayo Clinic; Pradeep Javarayee, MD – Medical College of Wisconsin; Jeffre Olaya, MD – Children’s Hospital Orange County; Daniel Shrey, MD – Children’s Hospital Orange County; Samir Karia, MD – University of Louisville; Jeetendra Sah, MD – University of Louisville; Adam Ostendorf, MD – Nationwide Children’s; Priyamvada Tatachar, MD – Lurie Children’s Hospital; Allyson Alexander, MD – University of Colorado, Childrens’ Hospital Colorado; Krista Eschbach, MD – University of Colorado, Childrens’ Hospital Colorado; Jeffrey Bolton, MD – Boston Children’s Hospital; Shilpa Reddy, MD – Vanderbilt University Medical Center; Michael Mccormack, MD – Vanderbilt University Medical Center; Rani Singh, MD – Atrium Health, Wake Forest University School of Medicine; Dewi Depositario-Cabacar, MD – Children’s National; Michael Ciliberto, MD – University of Iowa; Jason Coryell, MD – Oregon Health and Sciences University; Erin Romanowski, MD – University of Michigan; Nancy McNamara, MD – University of Michigan; Ernesto Gonzalez- Giraldo, MD – University of California-San Francisco; Joseph Sullivan, MD – University of California-San Francisco; Dave Clarke, MD – UT Health Austin
Rationale:
Generalized tonic seizures (GTS) are one of the characteristic seizure types of Lennox-Gastaut syndrome (LGS) although they may be seen in other epilepsies. GTS remain challenging due to high rate of pharmaco-resistance, particularly within the context of LGS, and high potential for injury. Corpus callosotomy (CC) is a common surgical intervention for GTS, but focal surgery (FS) may be an efficacious approach if a focal seizure onset zone is identified. The frequency of performing CC versus FS, and comparative efficacies of these approaches for GTS, is uncertain. This study sought to perform a comprehensive comparison of CC and FS, and their outcomes, for treatment of GTS in children.
Methods:
Children with GTS identified by semiology were followed as part of the Pediatric Epilepsy Research Consortium (PERC) surgery database, a platform aggregating prospective clinical and outcome data from children assessed for epilepsy surgery across >20 pediatric epilepsy centers in the USA. Only children with completed surgeries were included. Baseline patient characteristics and seizure outcomes were compared between those undergoing CC versus FS.
Results:
Of 54 patients, 40 (74%) underwent CC, and 14 (26%) FS. Children undergoing CC were older at referral for phase-1 evaluation (mean±4.9 years in CC group vs 6.8±1 SD=12.3±4.2 years in CC vs 7.4±5.5 years in FS). Cognitive/developmental delay was more common in the CC group (90% vs 57%). Genetic etiology was more common (35%) in the CC group vs structural (65%) in FS. A higher number of failed antiseizure medications was reported in the CC group (mean=7, range=1-17) compared to the FS group (mean=4, range=2-8). Abnormal MRI was more common in the FS (92%) vs CC group (48%). The proportion of patients undergoing additional testing beyond MRI and EEG was higher in the FS group, including PET, MEG, and neuropsychology. EEG localization was more likely to be generalized (64%) in the CC group vs multifocal (45%) in the FS group. At most recent clinical follow-up, FS cases had a higher rate of seizure freedom (19% in CC vs 80% in FS), and with 65% CC and 100% FS having >50% seizure reduction. See detailed results in Table 1 and Table 2.
Conclusions:
In this cohort, FS produced better outcomes compared to CC in children with drug-resistant GTS. In the context of GTS, consideration for further evaluation for focal seizure onset is of high priority when there is suspicion of potential focal structural abnormalities. For those without an identifiable focal seizure onset zone, palliative procedures such as CC are often delayed, though outcomes are generally favorable and delays likely unwarranted.
Funding: None
Surgery