Epilepsy Surgery in the Setting of Infantile Epileptic Spasms Syndrome: Predictors of Seizure Freedom
Abstract number :
1.45
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
1340
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Julia Sun, PhD – UCLA
Hiroki Nariai, MD, PhD, MS – UCLA Mattel Children's Hospital
Rajsekar Rajaraman, MD, MS – UCLA Mattel Children's Hospital
Noriko Salamon, MD,PhD – UCLA Mattel Children's Hospital
Raman Sankar, MD, PhD – University of California, Los Angeles
Gary Mathern, MD – UCLA
Aria Fallah, MD, MS – UCLA Mattel Children's Hospital
Shaun Hussain, MD, MS – UCLA Mattel Children's Hospital, David Geffen School of Medicine
Rationale: Infantile epileptic spasms syndrome (IESS) is a severe form of epileptic encephalopathy, often associated with medication refractoriness, evolution to other epilepsy syndromes, and adverse cognitive/behavioral outcomes. For select patients who fail first-line anti-seizure medications, surgical resection of epileptogenic brain regions can be curative. However, predicting post-surgical outcomes is challenging, with prior studies offering conflicting data on which factors best predict success. This study aims to identify predictors of seizure freedom among a large, single-center cohort of children with IESS.
Methods: We conducted a retrospective cohort study of children with IESS who underwent epilepsy surgery. Demographic, etiologic, neuroimaging, and electrophysiology data were extracted from electronic medical records. We evaluated the association between risk factors and latency to relapse using the Kaplan-Meier procedure and Cox proportional hazards regression. Candidate predictors included lateralization/localization of MRI, FDG-PET, and EEG abnormalities, as well as etiology, age at surgery, duration of epileptic spasms, presence of other seizures, and resection size.
Results: We identified 102 children with IESS who underwent surgical resection. The median (interquartile range) age of onset of IESS and age at surgical resection were 5.1 months (2.7–7.6) and 27.0 months (16.1–62.9), respectively. Twenty-six (25.5%) children experienced seizure recurrence within 1 year. All 10 subjects with stroke etiology were seizure free at 1 year. Shorter latency to recurrence was associated with tuberous sclerosis complex (TSC) (excluding stroke, HR 2.8, 95% CI 1.3–6.0, p=0.01), longer duration from IESS onset to first surgery (median split, HR 2.4, 95% CI 1.0–5.4, p=0.04), lobar resection (in comparison to hemispherectomy, HR 3.0, 95% CI 1.3–6.8, p=0.01), as well as presence of contralateral abnormalities on interictal EEG (HR 3.1; 95% CI 1.4–6.6; p=0.005), MRI (HR 4.5, 95% CI 2.1–9.7, p< 0.001), or neuroimaging (MRI and/or PET; HR 5.9; 95% CI 2.2–15.9; p< 0.001). Of note, eight cases exhibited seizure freedom at 1 year despite contralateral abnormalities on EEG or neuroimaging.
Surgery