Characteristics Affecting Decision to Not Offer Epilepsy Surgery Following Presurgical Evaluation Across US Pediatric Epilepsy Centers
Abstract number :
1.415
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2025
Submission ID :
90
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Avery Caraway, BS, MS – Cook Children's
Edward Novotny, MD – Seattle Children’s Hospital
Adam Ostendorf, MD – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Allyson Alexander, MD, PhD – Children’s Hospital of Colorado
Krista Eschbach, MD – Children Hospital Colorado
Lily C. Wong-Kisiel, MD – Mayo Clinic, Rochester, MN, USA.
Dewi Depositario-Cabacar, MD – Children’s National Hospital
Pilar Pichon, MD – Children's Hospital of Orange County
Daniel Shrey, MD – Children’s Hospital of Orange County
Jeffrey Bolton, MD – Boston Childrens Hospital
Samir Karia, MD – University of Louisville
Cemal Karakas, MD – University of Louisville
Erin Fedak-Romanowski, MD – University of Michigan
Nancy McNamara, MD – University of Michigan
Priyamvada Tatachar, MBBS, MD – Ann & Robert H. Lurie Children’s Hospital of Chicago
Ernesto Gonzalez-Giraldo, MD – University of California at San Francisco
Kurtis Auguste, MD – University of California at San Francisco
Danilo Bernardo, MD – University of California at San Francisco
Pradeep Javarayee, MD MBA – The Medical College of Wisconsin, Milwaukee
Rani Singh, MD – Atrium Health, Levine Children’s Hospital
Michael Ciliberto, MD – University of Iowa
Shilpa Reddy, MD – Vanderbilt University
Abhinaya Ganesh, MD – Vanderbilt University
Jason Coryell, MD – Oregon Health Sciences University
Andrew Knox, MD – University of Wisconsin-Madison
Kristen Arredondo, MD – University of Texas at Austin, Dell Medical School
Ahmad Marashly, MD – Johns Hopkins University
Debopam Samanta, MD – University of Arkansas
Jenny Lin, MD – Children’s Healthcare of Atlanta
Zachary Grinspan, MD, MS – Cornell Weill Medicine
Fernando Galan, MD – Nemours Children’s Health
Dallas Armstrong, MD – UT Southwestern
Steven M Wolf, MD – Westchester Medical Center, Hawthorne, NY, United States
Patricia McGoldrick, NP – New York Medical College
Janelle Wagner, PhD, FAES – Medical University of South Carolina
Sonal Bhatia, MD – Medical University of South Carolina
Taylor Abel, MD – Children's Hospital of Pittsburgh, UPMC
Shifteh Sattar, MD – University of California at San Diego
Jason Hauptman, MD, PhD – Phoenix Children’s Hospital
Matt Lallas, MD – Nicklaus Children’s Hospital
Ann Hyslop Segeren, MD – Stanford Medicine Children’s Health
Derryl Miller, MD – Indiana University School of Medicine
M. Scott Perry, MD – Cook Children’s Physician Network
Rationale: Surgery is an effective, yet underutilized, treatment for many children with drug resistant epilepsy (DRE). While factors associated with favorable outcome following surgery are known, the decision to offer surgical treatment rests with each epilepsy center. Threshold to offer surgery differs across institutions and may be related to center experience, resources, or other factors. We aim to assess the rate at which US centers decline to offer surgery as a treatment option after evaluating a child for surgical candidacy. We describe characteristics associated with this decision and the variability in candidate selection across institutions.
Methods: We queried the Pediatric Epilepsy Research Consortium Surgery database, a prospective, observational multicenter study enrolling children 0-18 years at 38 US pediatric epilepsy centers. We included data from sites enrolling all patients undergoing initial evaluation for surgical treatment of DRE. We analyzed patient and epilepsy characteristics, pre-surgical evaluation details, and compared across institutions based on the centers’ decision to offer epilepsy surgery following a phase I evaluation. We performed logistic regression on significant variables’ effect on decision to not offer surgery. Participating institutions provided program data, including annual number of evaluations for epilepsy surgery, epilepsy surgery conference participants, years of program experience, and National Association of Epilepsy Centers (NAEC) level. Correlation was tested between program data and surgery denial rates.
Results: Of the 3966 patients in the database, 2480 from 29 NAEC Level 4 centers were included. 532 (21%) were not offered epilepsy surgery, with median rate of 17% (IQR 10%-28%). Multiple factors had significant effect on the likelihood of candidacy (Table 1) and all showed significant variability when evaluated across institutions (Table 2). Logistic regression showed patients with monthly seizures (OR 2.25, 95% CI [1.81, 2.79], p < 0.01), non-structural etiology (OR 2.00, 95% CI [1.55, 2.59], p < 0.01), and those without fMRI (OR 2.49, 95% CI [1.88, 3.33], p < 0.01) had the highest likelihood of being declined surgery. Across centers, these variables were present in patients not offered surgery 0%-51%, 0%-59%, and 0%-61%, respectively. 21 centers provided program details. There was a strong correlation (Pearson’s r = -0.75) between number of conference participants and the rate of not offering surgery. Other variables had weak to no correlation (r < 0.35).
Surgery