Factors Associated with Favorable Surgical Outcomes in Children with Drug-resistant Epilepsy Secondary to Neonatal/perinatal Arterial Stroke: Insights from Pediatric Epilepsy Research Consortium
Abstract number :
2.455
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
212
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Siddharth Jain, MBBS MD – University of Louisville
M. Scott Perry, MD – Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center
Avery Caraway, MS – Cook Children's Medical Center
Emily Brock, BS – Cook Children's Medical Center
Jason Hauptman, MD – Seattle Children's Hospital
Edward Novotny, MD – University of Washington School of Medicine
Dewi Depositario-Cabacar, MD – Children's National Hospital
William Gaillard, MD – Children's National Hospital
Priyamvada Tatachar, MD – Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine
Jeffrey Bolton, MD – Boston Children's Hospital
Lily Wong-Kisiel, MD – Mayo Clinic College of Medicine
Erin Fedak Romanowski, MD – University of Michigan
Nancy McNamara, MD – University of Michigan
Krista Eschbach, MD – University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado
Allyson Alexander, MD, PhD – Children's Hospital Colorado
Kurtis Auguste, MD – University of California-San Francisco
Ernesto Gonzalez-Giraldo, MD – University of California-San Francisco
Adam Ostendorf, MD – Pediatrics, Division of Pediatric Neurology
Jason Coryell, MD – Oregon Health and Sciences University/Doernbecher Children's Hospital
Samir Karia, MD – University of Louisville School of Medicine/Norton Children's Hospital
Jeetendra Sah, MD – University of Louisville School of Medicine
Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Pilar Pichon, MD – Children's Hospital of Orange County
Daniel Shrey, MD – Children's Hospital of Orange County
Shilpa Reddy, MD, MMHC – Vanderbilt University Medical Center
Abhinaya Ganesh, MD – Vanderbilt University/Monroe Carell Jr Children's Hospital
Jenny Lin, MD – Children's Healthcare of Atlanta
Rani Singh, MD – Atrium Health/Levine Children's Hospital, Wake Forest University School of Medicine
Michael Ciliberto, MD – University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Ahmad Marashly, MD – The Johns Hopkins Hospital
Srishti Nangia, MD – Weill-Cornell Medicine
Debopam Samanta, MD – University of Arkansas for Medical Sciences
Kristen Arredondo, MD – University of Texas at Austin
Patricia McGoldrick, NP – Boston Children's Health Physicians
Steven Wolf, MD, FAES – Boston Children's Health Physicians
Ann Hyslop Segeren, MD – Stanford University School of Medicine
Dallas Armstong, MD – UT Southwestern
Cemal Karakas, MD – University of Louisville School of Medicine/Norton Children's Hospital
Rationale:
Neonatal and perinatal arterial strokes (PAIS) are significant causes of seizures in children, often leading to drug-resistant epilepsy (DRE), which may benefit from surgical intervention. We aimed to identify factors influencing seizure freedom or >90% seizure reduction in this cohort.
Methods:
We analyzed data from the Pediatric Epilepsy Research Consortium Surgery Database, a prospective, observational multicenter study enrolling children 0-18 years across 27 US pediatric epilepsy centers. We included data from January 2018 to April 2024 for patients with reported PAIS as an etiology of their DRE. Statistical comparisons of clinical features, diagnostic imaging findings, and surgical procedures were made between patients achieving seizure freedom versus others and those with >90% seizure reduction (“favorable outcome”) versus those with < 90%.
Results:
79/108 (73%) completed surgeries, with outcomes available for 71(90%) patients. Fifty-four (68%) patients had favorable outcomes, and 43 (54%) were seizure-free with a median follow-up of 17.5 months [IQR 9.5-27]. Age at seizure onset was significant; patients with onset after seven years had higher seizure freedom rates (76.5%) than those under seven years (48.4%, p=0.039). 73.2% of patients with PAIS as their only etiology achieved favorable outcomes compared to those with PAIS in addition to another etiology (congenital structural 50%, infectious/metabolic/genetic 0%) (p=0.04). EEG localization also mattered; 85% with single-focus EEG findings had favorable outcomes compared to lower rates in multifocal (50%), generalized (66.7%), or mixed generalized/focal findings (25%) (p=0.013). No significant differences were found in demographic variables, number of failed ASMs, seizure types, and specific diagnostic imaging (PET, MEG, SPECT) findings between the groups. Surgical procedures showed variable success. Hemispherectomy (n=36), callosotomy (n=3), lesionectomies (n=18), thermal ablation (n=7) had higher seizure freedom rates (69%, 66%, 61% and 61%, respectively) than neuromodulation (n=15) (6.7%) (p=0.001). Favorable outcomes ( >90% seizure reduction) were noted in 83% of hemispherectomy (n=36), 77% of lesionectomy/lobectomy (n=18), and 100% of thermal ablation cases (n=7) (p< 0.001). Patients undergoing neuromodulation were less likely to have single ictal electrographic focus (18.2% vs 65.6%, p=0.002), congruent MEG (66.7% vs. 100%, p=0.032), isolated encephalomalacia (28.6% vs.68.3%, p=0.004) and more likely to have PAIS plus etiologies (33.3% vs. 4.7%, p=0.001) when compared with other procedures.
Conclusions:
Following epilepsy surgery, over 50% of children with DRE secondary to PAIS achieved seizure freedom, and over 65% experienced significant seizure reduction. Earlier seizure onset, etiologies in addition to PAIS, and multifocal EEG findings are associated with unfavorable outcomes. Hemispherectomy and thermal ablation showed better outcomes than neuromodulation, reflecting patients with less favorable localizing findings.
Funding: None
Surgery