Authors :
Presenting Author: Nicole Mazaheri, BS – University of California, Los Angeles
Sotaro Kanai, MD, PhD – Division of Pediatric Neurology, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
Beck Reyes, NP – UCLA
Joyce Matsumoto, MD – UCLA
Aria Fallah, MD, MSc, MBA – Department of Neurosurgery, UCLA Medical Center, David Geffen School of Medicine
Shaun A. Hussain, MD, MS – Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine
Hiroki Nariai, MD, PhD, MS – Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
Rationale:
Surgical delay in pediatric epilepsy refers to the interval between seizure onset and the first epilepsy surgery. While previous studies have largely focused on adults, identifying factors contributing to surgical delay in children is crucial to optimizing timely interventions. This study investigated the key factors, both sociodemographic and clinical, for surgical delay in pediatric epilepsy patients at UCLA.
Methods:
We retrospectively reviewed 137 consecutive pediatric patients (ages 0–23) who underwent epilepsy surgery at UCLA between 2021 and 2025. For each patient, we collected detailed data on age at seizure onset, age at surgery, sex, insurance type (public vs. private), self-identified race (White, Asian, other), ethnicity (Hispanic or Non-Hispanic), developmental delay, epilepsy diagnosis (focal, generalized, Lennox-Gastaut syndrome [LGS], infantile spasms), etiology (structural, genetic, other), and surgical procedure (hemispherectomy, focal resection, callosotomy, neuromodulation, other). Surgical delay was defined as the time (years) from seizure onset to first epilepsy surgery. To address missing data, multiple imputation using chained equations was performed. Multivariable Cox proportional hazards regression assessed the impact of sociodemographic predictors on surgical delay. Additionally, Kaplan-Meier survival analyses with false discovery rate (FDR)-adjusted log-rank tests compared surgical delay across epilepsy diagnosis, etiology, and surgical procedure.
Results:
Demographic and clinical characteristics of the cohort are summarized in Table 1. The median age at surgery was 8.2 years (range: 0.4–22.9), and 53% were male. Kaplan-Meier survival analysis demonstrated that patients with LGS experienced substantially longer surgical delay compared to those with infantile spasms and generalized epilepsy (p = 0.0085 and 0.00093, respectively; Figure 1A), both of which were remained statistically significant after FDR correction. For etiology, patients with structural etiology had a longer delay compared to genetic and other etiologies (p = 0.027 and 0.033, respectively; Figure 1B), although these differences did not reach statistical significance after FDR correction. For surgical procedure type, those undergoing neuromodulation experienced longer delays relative to other surgical approaches (Figure 1C). In contrast, multivariable Cox regression revealed no statistically significant independent associations between surgical delay and any sociodemographic factors (Figure 1D).
Conclusions:
In this UCLA cohort, surgical delay in pediatric epilepsy was influenced by epilepsy diagnosis and surgery type, while etiology showed only a non-significant trend. Sociodemographic background was not independently associated with surgical delay. These results indicate the necessity for early identification and targeted referral for high-risk groups, such as those with LGS, to reduce surgical delay and contribute to beneficial long-term outcomes.
Funding:
This study is supported by the National Institute of Neurological Disorders and Stroke (NINDS) K23NS128318.