Abstracts

Rationale: Shorter duration to surgery is a modifiable contributor to adverse outcomes of intractable epilepsy, yet surgery is often delayed many years. Using a large, prospective, multicenter, pediatric epilepsy surgery database, we sought to describe characteristics of children referred for epilepsy surgery evaluation based on age and to identify factors which may lead to referral within 1 year (y) of intractability. Methods: Patients 0-18 y of age undergoing epilepsy surgery evaluation were enrolled prospectively in a shared REDCap database as part of the Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Project – a collaboration of 13 actively enrolling pediatric epilepsy centers. We collected predefined variables including patient demographics, epilepsy characteristics, presurgical treatment, evaluation, surgical therapy, and outcomes. Data were analyzed from project inception (1/1/18) to 4/30/19. Patients were divided based on age of surgical evaluation (< 3 and ≥ 3 y). Sociodemographic and epilepsy characteristics were compared to identify differences between the groups. We also performed a subgroup analysis in children with known age of intractability (i.e., failure of 2nd antiepileptic seizure drug) to understand characteristics associated with referral within 1 y of intractability (versus ≥ 1 y). Results: Data for 242 patients were available, 33 (14%) were < 3 y of age at time of referral. There were no significant differences in sociodemographic variables between those < 3 y and those older (Table 1). Patients referred < 3 y of age more often had daily seizures (64% vs 32%, p=0.003) of focal, impaired awareness type (96% vs 77%, p=0.02). Results of MRI and neurological examination were more commonly abnormal in those < 3 y, though the finding was not statistically significant (MRI abnormal 84% vs 70%; exam abnormal 61% vs 45%; p=0.09 for both comparisons). There were no differences in etiology or number of failed AEDs prior to referral. Age at intractability was provided for 136 (56%) patients. In this subgroup, patients < 3 y were referred within 1 y of intractability more often than older children (90% vs 47%, p<0.001) and mean time to referral was significantly shorter in children < 3y (4.0 months [0 – 4.8 IQR] v. 27.2 months [1.3 – 38.6 IQR], p=0.008). Children > 3y were referred within 1 y more often if their neurological exam was normal (p=0.01) but other factors were not associated with referral time. Abnormal neurological exams (vs normal) in children > 3y were associated with daily seizures (43% vs 23%, p=0.01) and use of public insurance (53% vs 25%, p<0.001). The only characteristic associated with rapid referral time in children < 3 years was proximity to the evaluating epilepsy center (p=0.03). Conclusions: Among all patients referred for epilepsy surgery evaluation, patients < 3 years of age have more frequent seizures and tend to have abnormal neurological exams and MRI findings. Children who become intractable < 3 y of age are referred more rapidly than older children. However, in older children, only a normal neurological exam is associated with rapid referral. Those with abnormal exams more often have daily seizures similar to children < 3y. This suggests a shift in threshold to recommend surgery based on age and neurological exam. These findings highlight an opportunity to decrease time to referral for epilepsy surgery evaluation in older children. Funding: No funding