Abstracts

Rationale: Epileptic spasms (ES), a rare form of epileptic encephalopathy often presenting in infancy to early childhood, are not always amenable to medical management. Previous articles have reported positive outcomes following surgical resection for refractory ES, but these studies have had small populations and varied results regarding seizure freedom rates. We are conducting a systematic review and meta-analysis to assess the rate and predictors of favorable seizure outcome after resective surgery for ES in pediatric patients.

Methods: This study protocol was registered on PROSPERO International Prospective Register of Systematic Reviews (CRD42022322156) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. EMBASE (Ovid), MEDLINE (PubMed), and Cochrane were searched for relevant terms (e.g., “epilepsy surgery,” “resective surgery,” “infantile spasms,” “epileptic spasms,” “West syndrome,” pediatric) without restrictions. We included randomized controlled trials, cohort and cross-sectional studies, and case series with ≥ 5 patients undergoing resective surgery for ES. Conference proceedings/abstracts, case reports, case series with < 5 subjects, reviews, and articles without an English translation were excluded. Extracted data included subject demographics, mean ages at ES onset and surgery, spasm etiology, MRI findings, surgical procedure(s), follow-up duration, and seizure freedom outcomes.

Results: The initial search identified 1,417 references, from which 354 duplicates were removed. Two authors independently screened 1,063 references by abstract review. The remaining 90 full-text articles were examined by the same two authors for compliance with the eligibility criteria. Excluded references (n = 64) consisted of 33 conference proceedings/abstracts, 26 articles with incomplete data, 3 with no English translation, and 2 with < 5 eligible subjects. 26 articles (594 patients total) were included in the analysis. Mean ages at ES onset and surgery were 1.29 ± 1.38 years and 3.91 ± 2.91 years, respectively. Mean follow-up duration was 4.8 ± 4 years. The overall seizure freedom rate (effect size) was 68.39% (SE = 2.19, 95% CI [64.10 - 72.68]). Using a random effect model, we found low heterogeneity across studies (Q = 32.95, I² = 24.12%).

Conclusions: Based on this meta-analysis, resective surgery has resulted in seizure freedom for the majority of children with ES. Although ES was thought to be a future of generalized epilepsy in the past, we now know that the surgical outcomes are comparable with focal epilepsy surgeries. Our findings highlight the need for more comprehensive studies, which could better inform management practices and be used in preoperative counseling. Further analysis will be conducted to assess prognostic factors, such as MRI findings and spasm etiology, pertaining to seizure freedom outcomes following surgical resection.

Funding: None