Influence of Diagnostic Testing on Surgical Outcomes in Non-lesional Focal Pediatric Epilepsy: Insights from PERC Cohort
Abstract number :
3.452
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
189
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Adam Ostendorf, MD – Pediatrics, Division of Pediatric Neurology
Ahmad Marashly, MD – The Johns Hopkins Hospital
Allyson Alexander, MD, PhD – Children's Hospital Colorado
Ammar Kheder, MD MRCP – Emory University School of Medicine
Cemal Karakas, MD – University of Louisville School of Medicine/Norton Children's Hospital
Dallas Armstong, MD – UT Southwestern
Daniel Shrey, MD – Children's Hospital of Orange County
Debopam Samanta, MD – University of Arkansas for Medical Sciences
Dewi Depositario-Cabacar, MD – Children's National Hospital
Edward Novotny, MD – University of Washington School of Medicine
Erin Fedak Romanowski, MD – University of Michigan
Ernesto Gonzalez-Giraldo, MD – University of California-San Francisco
Presenting Author: Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Jason Coryell, MD – Oregon Health and Sciences University/Doernbecher Children's Hospital
Jason Hauptman, MD – Seattle Children's Hospital
Jeetendra Sah, MD – University of Louisville School of Medicine
Jeffrey Bolton, MD – Boston Children's Hospital
Jenny Lin, MD – Children's Healthcare of Atlanta
Joffre Olaya, MD – Children's Hospital of Orange County
Joseph Sullivan, MD – University of California San Francisco Weill Institute for Neurosciences
Krista Eschbach, MD – University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado
Kristen Arredondo, MD – University of Texas at Austin
Kurtis Auguste, MD – University of California-San Francisco
Lily Wong-Kisiel, MD – Mayo Clinic College of Medicine
Michael Ciliberto, MD – University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Nancy McNamara, MD – University of Michigan
Patricia McGoldrick, NP – Boston Children's Health Physicians
Pilar Pichon, MD – Children's Hospital of Orange County
Priyamvada Tatachar, MD – Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine
Rani Singh, MD – Atrium Health/Levine Children's Hospital, Wake Forest University School of Medicine
Samir Karia, MD – University of Louisville School of Medicine/Norton Children's Hospital
M. Scott Perry, MD – Jane and John Justin Institute for Mind Health, Neurosciences Center, Cook Children's Medical Center
Shilpa Reddy, MD, MMHC – Vanderbilt University Medical Center
Srishti Nangia, MD – Weill-Cornell Medicine
Stephanie Burkhalter, APRN – Nemours Children's Health
Steven Wolf, MD, FAES – Boston Children's Health Physicians
William Gaillard, MD – Children's National Hospital
Abhinaya Ganesh, MD – Vanderbilt University/Monroe Carell Jr Children's Hospital
Avery Caraway, MS – Cook Children's Medical Center
Fernando Galan, MD – Nemours Children's Health
Rationale: Presurgical evaluations are crucial in determining the eligibility for surgery especially in non-lesional focal epilepsy (NLFE) cases. However, the lack of standardized evaluation methods creates uncertainties with regard to the influence of diagnostic tests on surgical eligibility and seizure outcomes. We analyzed the impact of MEG, PET, and SPECT evaluation on both surgical decisions and long-term outcomes in a multicenter pediatric NLFE cohort.
Methods: The Pediatric Epilepsy Research Consortium (PERC) Surgery Database is a prospective, observational study collecting data between Nov 2017 and Feb 2024 on children 0-18 years referred for epilepsy surgery across 23 US pediatric epilepsy centers. We assessed the relationship between presurgical evaluations (total number and type of tests) and the decision to offer surgery, the type of surgery offered (1-stage vs. 2-stage using invasive EEG), and seizure-free outcomes using multivariate logistic regression analysis.
Results: 296 NLFE patients from the PERC database (43% females, 74% white), with a mean age of 6.2 years at seizure onset were included. Patients failed 3.7 anti-seizure medications on average before undergoing phase I evaluation (mean age 12.1 years), followed by surgery at an average age of 13.2 years. In addition to MRI and non-invasive EEG, patients underwent MEG (113, 38%), SPECT (85, 29%), and PET (249, 84%) alone or in combination, according to individual center preferences (Table 1). Epilepsy surgery was offered to 221 individuals (75%): 149 (67%) were recommended invasive EEG evaluation, and 72 (33%) for single-stage surgery. At the time of analysis, 163 patients (55%) had undergone epilepsy surgery (101 after a 2-stage procedure and 62 after a 1-stage procedure).
A higher total number of presurgical tests was associated with the decision to offer invasive EEG monitoring (p=0.004) and surgery (p=0.02). Non-invasive evaluation increased the odds of offering invasive EEG monitoring to various degrees (Table 2). The presence of divergent results increased the likelihood of additional tests (p< 0.001), while congruent results increased the odds of offering surgery. No individual test or combination of tests predicted the decision to offer surgery. Despite the varied approaches to presurgical evaluation across centers, when stratifying surgeries by temporal/extratemporal or grouping by dominant versus nondominant hemispheres, seizure freedom at 2 years post-op was not impacted by the cumulative number of tests, their combinations, or congruent results (Table 2).
Surgery