Acute Postoperative Seizures (APOS) in Pediatric Epilepsy Surgery Occurring Less Than 7 Days versus Greater Than 7 to 30 Days: Is There a Difference in Long Term Outcome?
Abstract number :
2.447
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
314
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Sanam Zarei, MD – Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC
Kathryn Havens, PA-C – Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC
Chima Oluigbo, MD – Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC
Louis-Gilbert Vezina, MD – Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC
Nathan Cohen, MD – Children's National Hospital
John Schreiber, MD – Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC
Thuy Vu, MD – Children’s National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC
William Gaillard, MD – Children's National Hospital
Dewi Depositario-Cabacar, MD – Children's National Hospital
Rationale: There are limited studies on pediatric epilepsy surgery and Acute Postoperative Seizures (APOS). Previous studies have defined APOS as less than 7 days but recently it has been expanded to 30 days. We compared APOS occurring < 7 days to APOS occurring between 7-30 days to determine if there was a difference in long term outcome.
Methods: We retrospectively identified patients at our institution who underwent epilepsy surgery from January 1, 2006 – June 30, 2023 with at least a 6 month follow-up. Our IRB approved database was queried for demographics, EEG, MRI, surgery type, pathology, seizure semiology, and Engel outcome.
Results: Out of 472 patients, 67 had APOS (14.2%) and 3 were excluded due to follow-up time. 26/64 (40.6%) and 38/64 (59.4%) met criteria for < 7 days and >7 days, respectively.
In the < 7 day group, mean age of seizure onset was 3.0 years. Seizures were focal (16), mixed (8), and generalized (2). EEG findings were unilateral (19), bilateral (2), multifocal (3), hemispheric (1), and generalized (1). 23/26 (88.5%) had a lesional MRI and 19/26 (73.1%) had an EEG concordant with MRI. Lesional findings included focal cortical dysplasia (14), tubers (4), encephalomalacia (3), heterotopia (1), and hemimegalencephaly (1). The Engel score was 1 (n=7), 2 (n=3), 3 (n=8), and 4 (n=8) with 38.4% with a score of 1-2 of 38.4% and 61.6% with a score of 3-4.
In the >7 day group, mean age of seizure onset was 4.2 years. Seizures were focal (33) and mixed (5). EEGs were unilateral (32), bilateral (2), multifocal (3), and generalized (1). 30/38 (78.9%) had a lesional MRI and 29/38 (76.3%) had an EEG concordant with MRI. Lesional findings included focal cortical dysplasia (16), encephalomalacia (4), tubers (3), other cortical malformation (2), neoplasm (2), mesial temporal sclerosis (1), hemimegalencephaly (1), and vascular malformation (1). The Engel score was 1 (n=10), 2 (n=2), 3 (n=20), and 4 (n=6) with 31.6% with a score of 1-2 and 68.4% with a score of 3-4.
For all cases, 22/64 (34.4)% had Engel scores 1-2 and 42/64 (65.6%) had Engel scores 3-4. For those with Engel scores 3-4 in the APOS < 7 day and >7 day cohorts, 15/16 (93.8%) and 22/23 (95.7%) either had incomplete resection, non-lesional MRI, non-focal findings on pre-operative EEG, non-concordant EEG with MRI, and abnormal post-operative EEG, respectively.
Semiology for the < 7 days group were similar in 17/26 and 7/26 had a different semiology from patient’s reported baseline. Engel 4 score was 35.3% and 14.3% for those with similar and different semiology, respectively. For the >7-30 days group, 22/38 had similar semiology and 16 had a different semiology. Engel 4 score was not significantly different for both similar and different (18%) semiology.
Conclusions: APOS was associated with poor surgical outcome regardless of timing. Poor surgical outcomes were seen more frequently with similar semiology for APOS occurring < 7 days but not for APOS >7-30 days. Factors influencing poor outcomes are incomplete resection, non-lesional MRI, lack of concordance of EEG and MRI, and non-localizing EEG. Despite APOS, some patients who had concordant EEG and MRI findings with complete resection had good long-term outcome.
Funding: None
Surgery