Testing and Treatment Choices in Pediatric Mri-negative Frontal Lobe Epilepsy: A Census Survey of NAEC Center Directors
Abstract number :
3.324
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2205080
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Stephanie Ahrens, DO – Nationwide Children's Hospital; Kristen Arredondo, MD – Nationwide Children's Hospital; Anto Bagic, MD, PhD – University of Pittsburgh; Shasha Bai, PhD – Emory University School of Medicine; Christopher Beatty, MD – Nationwide Children's Hospital; Kevin Chapman, MD – Barrow Neurological Institute at Phoenix Children’s Hospital; Michael Ciliberto, MD – Stead Family Children’s Hospital, University of Iowa; Dave Clarke, MD – UT Health Austin Pediatric Neurosciences at Dell Children’s Comprehensive Pediatric Epilepsy Program; Mariah Eisner, MS – Nationwide Children's Hospital; Nathan Fountain, MD – University of Virginia; Jay Gavvala, MD – Baylor College of Medicine; M. Scott Perry, MD – Cook Children’s Medical Center; Kyle Rossi, MD – Beth Israel Deaconess Medical Center and Harvard Medical School; Lily Wong-Kisiel, MD – Mayo Clinic; Susan Herman, MD – Barrow Neurological Institute Comprehensive Epilepsy Center; Adam Ostendorf, MD – Nationwide Children's Hospital
Rationale: The evaluation to determine candidacy and treatment for epilepsy surgery in persons with drug-resistant epilepsy is not uniform. Many non-invasive and invasive tests can be used to ascertain an appropriate treatment strategy. This study examines expert opinions regarding a clinical vignette of pediatric MRI-negative frontal lobe epilepsy.
Methods: We analyzed annual report data1 and a supplemental survey performed in 2019-2020 from 135 epilepsy center directors in the United States. The scenario was as follows: A 10-year-old right-handed girl has intractable focal seizures characterized by rightward gaze deviation, altered awareness and progression to right upper extremity tonic clonic movements prior to generalizing. Her exam and MRI are normal. Her continuous EEG monitoring captured 4 seizures with rhythmic spikes in F3 and C3 with rapid spread._x000D_
Noninvasive, invasive and surgical treatment strategies were compiled. Dichotomous outcomes, including each individual non-invasive and invasive test, were modeled with multivariable logistic regression. For the treatment approach outcome which had three categories modeled, multinomial logistic regression models were built. Estimates were exponentiated and presented as odds ratios (OR) with 95% confidence intervals.
Results: The supplemental survey response rate was 100% with 135 observations included in the analyses. The most common non-invasive tests recommended were neuropsychology testing (90%), FDG-PET (85%) and fMRI (72%) (Table 1). SEEG was selected by 72% of respondents, and open resection was the most common treatment choice (72%). Wada was associated with higher odds of selecting intraoperative ECOG (OR 3.03; 95% CI, 1.03-8.71; p = 0.04) and/or grids and strips (OR 2.92; 95% CI, 1.07-8.69; p = 0.04) (Table 2). fMRI was associated with greater odds of choosing SEEG (OR 2.52; 95% CI, 1.01-6.35; p = 0.05). Treatment choices were not significantly associated with specific non-invasive tests or invasive tests. _x000D_
Center characteristics were associated with several non-invasive tests. For instance, center directors from the South had lower odds of choosing Wada compared to those in the Midwest (OR 0.053; 95% CI, 0.005-0.366; p = 0.006). Center characteristics were not associated with invasive test choice. Pediatric-only centers (vs. combined adult and pediatric centers) had greater odds of recommending laser ablation compared to open resection (OR 14.16; 95% CI, 2.3-87.1; p = 0.004).
Conclusions: In a vignette of pediatric MRI-negative frontal lobe epilepsy, epilepsy center directors displayed various patterns of noninvasive testing, invasive testing, and treatment choices. The results of this large census survey provide insight into current practice in the U.S. and highlight specific areas of variability.
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Reference:_x000D_
1. Ostendorf AP, Ahrens SM, Lado FA, et al. United States Epilepsy Center characteristics: a data analysis from the National Association of Epilepsy Centers. Neurology. 2022;98(5):e449-e458. Published online ahead of print December 8, 2021. doi: 10.1212/WNL.0000000000013130
Funding: This study was supported by Nationwide Children’s Hospital Foundation and the National Association of Epilepsy Centers.
Surgery