Factors Influencing Surgical Approach and Seizure Outcomes in Pediatric Mri-positive Temporal Lobe Epilepsy: One-stage versus Two-stage Surgical Interventions
Abstract number :
1.451
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
1283
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Cemal Karakas, MD – University of Louisville School of Medicine/Norton Children's Hospital
Avery Caraway, MS – Cook Children's Medical Center
Emily Brock, BS – Cook Children's Medical Center
Jason Hauptman, MD – Seattle Children's Hospital
Edward Novotny, MD – University of Washington School of Medicine
Dewi Depositario-Cabacar, MD – Children's National Hospital
William Gaillard, MD – Children's National Hospital
Priyamvada Tatachar, MD – Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine
Jeffrey Bolton, MD – Boston Children's Hospital
Lily Wong-Kisiel, MD – Mayo Clinic College of Medicine
Erin Fedak Romanowski, MD – University of Michigan
Nancy McNamara, MD – University of Michigan
Krista Eschbach, MD – University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado
Allyson Alexander, MD, PhD – Children's Hospital Colorado
Kurtis Auguste, MD – University of California-San Francisco
Ernesto Gonzalez-Giraldo, MD – University of California-San Francisco
Adam Ostendorf, MD – Pediatrics, Division of Pediatric Neurology
Jason Coryell, MD – Oregon Health and Sciences University/Doernbecher Children's Hospital
Samir Karia, MD – University of Louisville School of Medicine/Norton Children's Hospital
Jeetendra Sah, MD – University of Louisville School of Medicine
Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Pilar Pichon, MD – Children's Hospital of Orange County
Daniel Shrey, MD – Children's Hospital of Orange County
Shilpa Reddy, MD, MMHC – Vanderbilt University Medical Center
Abhinaya Ganesh, MD – Vanderbilt University/Monroe Carell Jr Children's Hospital
Jenny Lin, MD – Children's Healthcare of Atlanta
Rani Singh, MD – Atrium Health/Levine Children's Hospital, Wake Forest University School of Medicine
Michael Ciliberto, MD – University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Ahmad Marashly, MD – The Johns Hopkins Hospital
Srishti Nangia, MD – Weill-Cornell Medicine
Debopam Samanta, MD – University of Arkansas for Medical Sciences
Kristen Arredondo, MD – University of Texas at Austin
M. Scott Perry, MD – Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center
Rationale: This study aimed to determine the factors influencing the decision to perform one-stage versus two-stage surgical interventions and to compare seizure outcomes in pediatric patients with MRI-positive temporal lobe epilepsy (TLE).
Methods: We analyzed data from the Pediatric Epilepsy Research Consortium Surgery Database, collecting prospective and observational data between January 2018 and April 2024 from children (< 18 years of age) assessed for epilepsy surgery across 22 pediatric epilepsy centers in the USA. This study included patients with MRI-positive TLE who underwent epilepsy surgery, categorized into one-stage (without intracranial monitoring) and two-stage (with intracranial monitoring) groups. A multivariate logistic regression analysis was used to identify factors associated with the choice of one vs. two-stage surgeries. Clinical characteristics and seizure outcomes were compared between the groups.
Results: The study included 352 patients (248 one-stage vs 104 two-stage surgeries). Patients undergoing one-stage procedure more often had MRI-evident lesions congruent with EEG localization (p=0.04), whereas those undergoing two-stage surgeries more often had abnormal findings on neurological exam (p=0.001), higher median number of antiseizure medications (ASMs) (p < 0.001), neuropsychological testing (p=0.001) and more often underwent neuromodulation (p=0.01) and procedures including regions in addition to the temporal lobe (p=0.02). There were no significant differences when comparing individual races though White patients were 2.59 times more likely to receive 2 stage surgery than Black patients. Follow-up outcomes demonstrated no significant difference in the proportion of patients achieving seizure freedom between the groups (p=0.09). Regression analysis revealed that an abnormal neurological exam (OR=1.86, p=0.03), the number of current ASMs (OR=1.52, p=0.01), divergent MRI and EEG findings (OR=4.14, p=0.002), completion of neuropsychological testing (OR=8.5, p < 0.001) and inclusion of extra-temporal region (OR=0.42, p=0.02) for surgery were significantly associated with the choice of a two-stage surgeries. Subgroup analysis in patients with mesial temporal sclerosis (n=48) or focal cortical dysplasia (n=68) revealed no differences between the two surgery groups with regards to seizure free rates, (p=0.76 and p=0.88, respectively).
Conclusions: This study demonstrates that in pediatric MRI-positive TLE, two-stage surgical interventions allow similar seizure-free outcomes compared to one-stage procedures in patients with more complex epilepsy presentations, such as those with divergent MRI and EEG findings, abnormal neurological exams, and involvement of extra-temporal regions. This finding underscores the necessity of a judicious selection process for determining the surgical approach, emphasizing that invasive monitoring may not universally translate to better seizure control but can be crucial for achieving similar outcomes in complex cases.
Funding: n/a
Surgery