Associations Between Testing and Treatment Pathways in Lesional Temporal or Extratemporal Epilepsy: A Census Survey of NAEC Center Directors
Abstract number :
2.296
Submission category :
9. Surgery / 9C. All Ages
Year :
2022
Submission ID :
2205112
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Adam Ostendorf, MD – Nationwide Children's Hospital; 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
Rationale: The evaluation to determine candidacy and treatment for epilepsy surgery in persons with drug-resistant epilepsy (DRE) is not uniform. Many noninvasive and invasive tests can be used to ascertain an appropriate treatment strategy. This study examines expert response to clinical vignettes of lesional temporal and lesional extratemporal epilepsy to identify associations in evaluations.
Methods: We analyzed annual report data1 and a supplemental epilepsy practice survey reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Noninvasive, invasive and surgical treatment strategies were compiled for two vignettes, one with lesional temporal lobe epilepsy and the other with lesional frontal lobe epilepsy. We used chi-square tests for comparison of testing utilization between the two scenarios. Multivariable modeling was also performed to assign odds ratios of significant variables.
Results: The supplemental survey response rate was 100% with 342 observations included in the analyses. Differing testing and treatment approaches were noted between the temporal and extratemporal scenarios such as chronic intradural monitoring selected in 60% of the temporal scenario versus 93% of the extratemporal scenario. Open resection was the most common treatment choice, however overall treatment choices varied significantly (p < 0.001). Associations between noninvasive testing, invasive testing, and treatment choices were present with both scenarios. As an example of the associations between non-invasive and invasive testing, selecting SEEG in the temporal scenario was more commonly associated with FDG-PET (OR 1.85; 95% CI 1.06-3.29; p=0.033), MEG (OR 2.90; 95% CI 1.60-5.28; p = < 0.001), HD EEG (OR 2.80; 95% CI 1.27-6.24; p = 0.011), fMRI (OR 2.17; 95% CI 1.19-4.10; p = 0.014) and Wada (OR 2.16; 95% CI 1.28-3.66; p = 0.004). Regarding the relationship between invasive testing and treatment, selecting SEEG in the extratemporal scenario was associated with increased odds of selecting neuromodulation over open resection (OR 3.13; 95% CI 1.24-7.89; p = 0.016).
Surgery