Authors :
Presenting Author: Carmen Barba, MD, PHD – Meyer Children's Hospital IRCCS
Federico Vigevano, MD – IRCCS San Raffaele, Rome, Italy
Laura Tassi, MD – Niguarda Hospital, Milan, Italy
Renzo Guerrni, MD – Meyer Children's Hospital IRCCS
Marco De Curtis, MD – Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
Luca De Palma, MD – Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Giancarlo Di Gennaro, MD – Epilepsy Center, IRCCS Neuromed, Pozzilli, Isernia, Italy
Lino Nobili, MD – IRCCS Istituto Giannina Gaslini, Genova, Italy
Matteo Martinoni, MD – IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurosurgical Unit, Bologna, Italy
Stefano Meletti, PhD, MD – UNIMORE
Domenica I Battaglia, MD, PhD – Fondazione Policlinico Universitario Agostino Gemelli, IRCCS
Elisabetta Cesaroni, MD – Pediatric Hospital G. Salesi; AOU delle Marche, Ancona, Italy
Roberta Vittorini, MD – AOU Città della Salute e della Scienza di Torino, Turin, Italy
Laura Grisotto, PhD – University of Ferrara, Ferrara, Italy
Gianpiero Tamburrini, MD – Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
Giovanni Morana, MD – AOU Città della Salute e della Scienza di Torino, Turin, Italy
Matteo Pugnaghi, MD – AOU Modena, Modena, Italy.
Anna elisabetta Vaudano, MD – AOU Modena, Modena, Italy.
Francesca Bisulli, MD – Department of Biomedical and NeuroMotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
Alessandro Consales, MD – IRCCS Istituto Giannina Gaslini, Genova, Italy
Giulia Nobile, MD – IRCCS Istituto Giannina Gaslini, Genova, Italy
Vincenzo Esposito, MD – IRCCS NEUROMED, Pozzilli (IS), Italy
Elena Freri, MD – Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
Carlo Efisio Marras, MD – Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Flavio Giordano, MD – Meyer Children's Hospital IRCCS
Veronica Pelliccia, MD – Niguarda Hospital, Milan, Italy
Nicola Specchio, MD, PhD, FRCP – Bambino Gesù Children’s Hospital, IRCCS, Member of the ERN EpiCARE; University Hospitals KU
Michele Rizzi, MD – Instituto Neurologico Besta
Michela Quintiliani, MD – Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome Italy
Francesca Torta, MD – AOU Città della Salute e della Scienza di Torino, Turin, Italy
Laura Castana, MD – Niguarda Hospital, Milan, Italy
Flavio Villani, MD – IRCCS San Martino Policlinic Hospital, Genoa, Italy.
Giuseppe Didato, MD – Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
Rationale:
Epilepsy surgery represents the optimal treatment option for as many as 40% of patients with drug-resistant focal epilepsy (DRE). During and after the Covid-19 pandemic, presurgical and epilepsy surgery activities were severely affected, due to the reduction of elective procedures and the need to prioritize admissions of Covid-19 patients in most hospitals. These aspects were particularly dramatic in Italy, one of the first heavily affected countries in Europe since February 2020.
Methods:
The Epilepsy Surgery Task Force of the National Virtual Epilepsy Institute, member of the IRCCS Network of Neurosciences and Neurorehabilitation Clinical Research Institutes recognized the need to collect information on the possible changes in surgical volumes, complications, and outcomes determined by the Covid-19 pandemic in Italy. We then launched a survey through the Italian National Virtual Epilepsy Institute and associated epilepsy surgery centersto collect data on changes in surgical volumes and complications, and seizure outcomes between 2018 and 2022, i.e., before and after the Covid-19 outbreak in Italy.Results:
Eleven centers with established epilepsy surgery programs responded to the survey. Globally, 618 surgeries were performed in children and 621 in adults (total 1239) between 2018 and 2022. The most frequent type of surgery was unilobar extratemporal lobectomy for children (38.7%) and unilobar temporal lobectomy for adults (63.3%). The number of surgical interventions was significantly higher in the Northern compared to Central- Southern regions. Multilobar surgeries and procedures in patients with non-revealing MRIs were significantly more frequent in the Northern regions, whereas unilobar extratemporal resections were relatively more common in the Central-Southern areas. At the onset of Covid outbreak in Italy (March 2020), a significant decrease in the total number of operations was observed compared to 2019, especially for hemispheric interventions (p=0.027). Surgical volumes resumed in 2021, particularly for temporal lobe epilepsies and in adult cohorts. Surgical complications increased significantly in 2020, while seizure outcome remained stable over time.
In addition, we observed a slightly more pronounced decline in the volumes of surgeries in 2020 in Northern Italy compared to the Central-Southern regions, which appears to be driven more by the markedly uneven impact of the Covid-19 pandemic across regions than by inherent disparities in regional healthcare infrastructures.
Conclusions:
Following the outbreak of the Covid-19 pandemic in Italy, there was a decrease in volume activity and an increase in complications. Starting in 2021, epilepsy surgery volumes returned to pre-pandemic levels, though with slightly less complexity. Meanwhile, seizure outcomes have remained steady.Funding: This study received no funding