Outcomes and Prognostic Factors of Pediatric Frontal Lobe Epilepsy Surgery: A Multi-center Study
Abstract number :
1.337
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204749
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Ahmad Marashly, MD – The Johns Hopkins Hospital; Reena Elizebath, BS – The Johns Hopkins Hospital; Sean Lew, MD – Medical College of Wisconsin; Allyson Alexander, MD – University of Colorado School of Medicine; Dallas Armstrong, MD – University of Texas Southwestern; Jeffery Bolton, MD – Boston Children's Hospital; Emily Brock, BS – Cook Children's Hospital; Michael Ciliberto, MD – University of Iowa; Jason Coryell, MD, MS – Oregon Health & Sciences University; Dewi Depositario-Cabacar, MD – Children's National; Krista Eschbach, MD – University of Colorado School of Medicine; Satyanarayana Gedela, MD – Children's Healthcare of Atlanta; Zachary Grinspan, MD, MS – Weill Cornell Medicine; Samir Karia, MD – University of Louisville; Jennifer Koop, PhD – Medical College of Wisconsin; Chad Manuel, MD – Vanderbilt University Medical Center; Michael McCormack, MD – Vanderbilt University Medical Center; Srishti Nangia, MD – Weill Cornell Medicine; adam Numis, MD, PhD – UCSF; Joffre Olaya, MD – Children’s Hospital of Orange County; Shilpa Reddy, MD – Vanderbilt University Medical Center; Debopam Samanta, MD – University of Arkansas for Medical Sciences; Sabrina Shandley, PhD – Cook Children's Hospital; Rani Singh, MD – Atrium Health; Joseph Sullivan, MD – UCSF; Priyamavada Tatchar, MD – Lurie Children's Hospital; Steven Wolf, MD – Boston Children's Hospital; Lily Wong-Kisiel, MD – Mayo Clinic; Scott Perry, MD – Cook Children's Hospital
Rationale: Frontal lobe epilepsy (FLE) is one of the most common focal epilepsies in childhood. However, the surgical outcomes of FLE compared to temporal and hemispheric epilepsies is relatively unknown in the pediatric population and only a few studies explored various preoperative variables affecting frontal lobe surgical outcomes. This can be in part explained by underutilization of epilepsy surgery for this patient population, owing to the complex and diverse presentations of FLE. We evaluated the various pre-operative variables that may predict positive outcomes, defined as at least 90% seizure reduction compared to baseline, in a multi-center set of pediatric patients who underwent resective surgery for FLE.
Methods: The Pediatric Epilepsy Research Consortium (PERC) surgery database was used to identify patients below 20 years of age who underwent resective frontal lobe epilepsy surgery and followed-up for at least 12 months post-operatively. For patients who received multiple surgeries, clinical variables and outcomes were collected from the most recent surgery with at least 12 months of post-operative follow-up. The patient data was initially divided into groups with positive (≥90% seizure reduction) or negative (< 90% seizure reduction) outcomes to assess differences in data between these two groups. We then computed a series of multivariate binomial logistic regression models, starting with all predictors assessed to have significant differences between the two outcome groups in the preliminary analysis. Predictors were iteratively removed to arrive at a final model with minimized residuals.
Results: Fifty-eight patients met the inclusion criteria, 31 males and 27 females. The median age of epilepsy onset was 3 years (IQR = 8.6 years), and median age at the time of surgery was 9 years (IQR = 10 years). Most common etiologies were focal cortical dysplasia (FCD) in 46.6% (n=27) and tumors in 6.9% (n=4). However, 27.6% (n=16) of patients had non-lesional brain magnetic resonance imaging (MRI). The mean follow up duration was 22 months (SD=8.35). Seizure freedom was achieved in 53.4% of patients (n=31) and 6.9% (n=4) had 90% or more seizure reduction with an overall 60.3% of patients (n=35) achieveing positive outcomes. The positive and negative outcome groups showed no significant differences in gender distribution, race, ethnicity, etiology of epilepsy, seizure frequency, neurological exam results, or prior failure of vagal nerve stimulator or diet therapy. The only variables to significantly predict outcome were age of onset (p = 0.02; positive predictor) and the need for invasive EEG monitoring (p = 0.01; negative predictor)._x000D_
Conclusions: Epilepsy surgery outcomes in children with frontal lobe epilepsy are excellent with ~ 60% of children achieving seizure freedom or >90% seizure reduction, consistent with the previously known outcomes. FCD was the most common structural pathology, but a considerable portion of patients had MRI negative frontal lobe epilepsy. Excellent outcomes were more often seen in patients with a later onset of epilepsy, whereas the need for invasive monitoring predicted less favorable outcomes.
Funding: None
Surgery