Utilization of Diagnostic Modalities in Pediatric Epilepsy Surgery: the Pediatric Epilepsy Research Consortium Epilepsy Surgery Experience
Abstract number :
156
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2020
Submission ID :
2422504
Source :
www.aesnet.org
Presentation date :
12/5/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Lily Wong-Kisiel, Mayo Clinic Rochester; Allyson Alexander - University of Colorado Anschutz Medical Center; Priya Tatachar - Ann & Robert H. Lurie Children's Hospital of Chicago; Shilpa Reddy - Vanderbilt University Medical Center; Jeffrey Bolton - Bosto
Rationale:
Scalp video EEG monitoring and MRI findings direct the need for additional localizing modalities to recommend epilepsy surgery. Noninvasive presurgical evaluations are dependent on the resources and expertise of individual centers. In a multicenter pediatric epilepsy surgery database, we evaluated the utilization of diagnostic modalities in children with refractory epilepsy undergoing surgical evaluation.
Method:
Nineteen pediatric epilepsy centers in the United States prospectively enrolled patients 0-18 years of age undergoing epilepsy surgery evaluation between 1/1/2018 and 6/13/2020 as part of the Pediatric Epilepsy Research Consortium Epilepsy Surgery Project. Variables included patient demographics, epilepsy characteristics, presurgical treatment, evaluation, and opinions regarding epilepsy surgery from multidisciplinary epilepsy surgery conferences. Congruency of a diagnostic evaluation was defined as localizing within the same hemisphere as the EEG localization. Wilcoxon rank sum test compared continuous data. A chi-square test assessed association of categorical data.
Results:
Consensus opinions regarding epilepsy surgery were available for 492 patients with the following recommendations: no surgery for 21%, one-stage surgery for 43%, and further invasive monitoring for 35%. Video EEG showed a single ictal localization with congruent MRI abnormality in 41%. Consensus opinion was rendered after video EEG and MRI in 35%, after one additional modality in 33%, and after two or more modalities in 32%. FDG-PET was performed in 56%, peri-ictal SPECT in 26%, and MEG dipole cluster analysis in 21%. Compared to those who underwent additional evaluations, children who received a surgical recommendation after video EEG and MRI alone had a younger age of onset (2.9 (IQR 0.5-7) years vs 4.5 (IQR 1-9.1) years, p< 0.05), were more likely to have abnormal MRI (87% vs 74%, p< 0.05), and were less likely to receive a recommendation for invasive monitoring (15% vs 46%, p< 0.0001). Sex, race, ethnicity, age of referral, duration of epilepsy, or discordance between MRI abnormality and EEG localization did not contribute to number of additional evaluations (Table). Congruency with video EEG lateralization was in seen in 303/383 (79%) patients with abnormal MRI, 201/275 (73%) patients with PET, 75/105 (71%) patients with MEG dipoles, and 58/130 (45%) patients with peri-ictal SPECT.
Surgery