Abstracts

Rationale: Resective epilepsy surgery has been a mainstay in treatment for drug-resistant epilepsy (DRE) for select candidate groups within the pediatric population. Focal resective epilepsy surgery in children has been shown to result in 45% seizure freedom for non-lesional epilepsy and 74% seizure freedom for lesional epilepsy (Tellez-Zenteno, et al., 2010); however, many families shy away from pursuing this option due to its highly invasive nature. Laser Interstitial Thermal Therapy (LITT) has been increasingly utilized as a minimally invasive option for lesional and non-lesional DRE in the pediatric population. There have been limited studies published on comparative outcomes. The objective of this study was to analyze and compare the outcomes of focal resective surgery and LITT interventions in children with drug‐resistant focal epilepsy. Methods: We searched Texas Children's Hospital REDCAP database from 2/2016 to 12/2016. Primary exclusionary criteria included hypothalamic hamartomas cases and corpus callosotomy cases. For patients with multiple interventions, we used the outcomes from the last intervention. We determined Engel outcomes from either epilepsy and neurosurgery clinical follow-up notes and assigned each case in accordance with Engel's classifications. Good outcome was defined as Engel classes I /II and bad outcome as Engel classes III/IV. We compared the outcomes between resection and LITT at 1 year following intervention. Additionally, we compared changes in Engel classification between resection and LITT from 1st year to 2nd year following the intervention. Descriptive and chi square statistics were performed for the study. Results: We identified 145 cases for analyses. At Year 1, there were 10 LITT cases and 3 resection cases that were lost to follow-up, leaving 132 cases (22 LITT, 110 resection). At Year 2, there were 6 LITT cases and 18 resection cases lost to follow-up, leaving 108 cases (16 LITT, 92 resection). Mean age at seizure onset was 2.33 years for LITT (range 0-12 years) and 5.13 years for resection (range 0-18 years). Mean age at time of intervention was 8.97 years for LITT (range 0.5-20.17 years) and 11.33 years for resection (range 0.66 to 22.17 years). There was no statistical difference in Year 1 outcome between the LITT and resection cases (good/bad outcome: 15/7 vs. 79/31, LITT vs. resection, p = 0.8). At Year 2, in the LITT category, 2 cases were worse and 14 were the same and/or better. In the resection category, 9 cases were worse and 83 cases were the same and/or better. There was no statistically significant difference in surgical outcome between LITT and resection (p=0.3). Conclusions: We conclude that both LITT and resective surgery are effective in significantly reducing or eliminating seizures, with no statistical difference found at one- and two-year follow up. With these results demonstrating non-inferiority, we feel that LITT may be an option for select groups of children being considered for surgical intervention. Funding: No funding