Abstracts

Rationale: The mortality of pediatric patients with drug-resistant epilepsy (DRE) is higher than the general population and adult patients. A better understanding of the treatment effect on mortality is needed for healthcare decision-making. This study compared the long-term survival rate associated with different types of therapy in pediatric patients with DRE._x000D_  _x000D_ Methods: Patients aged 0-17 years and diagnosed with DRE between January 1, 2004 and December 31, 2020 were identified from the Pediatric Health Information System database. Patients treated with antiseizure medications (ASMs) only or ASMs plus vagus nerve stimulation (VNS) or ASMs plus cranial epilepsy surgery were included in the study and were followed until the date of their last clinical encounter, in-hospital death, or December 21, 2020. Kaplan-Meier and log-rank test were used to estimate and test the difference in the unconditional probability of survival. Cox proportional hazards model was performed to compare time-to-death in the follow-up period._x000D_  _x000D_ Results: This study included 10,240 patients treated with ASMs only, 5,019 patients treated with VNS, and 3,033 patients treated with cranial epilepsy surgery. The unconditional probabilities of surviving beyond 10 years were 89.93% for the medical therapy cohort (95% CI, 88.56% to 91.30%), 93.38% for the VNS cohort (95% CI, 91.81% to 94.95%), and 98.29% for the cranial surgery cohort (95% CI, 97.31% to 99.27%). The difference was statistically significant (p < 0.001). Compared with patients in the medical therapy cohort, the risks of overall death were reduced by 33% (HR=0.67; 95% CI, 0.51 to 0.86) and 83% (HR=0.17; 95% CI, 0.11 to 0.21) for patients in the VNS cohort and the cranial epilepsy surgery cohort, respectively. _x000D_  _x000D_ Conclusions: Our findings suggest survival benefits with surgical treatments for DRE and point to the need for increased and more timely evaluations and referrals to comprehensive epilepsy centers where surgical treatments are available._x000D_  _x000D_ Funding: The authors received no financial support for the research, authorship, and/or publication of this abstract.