Medical-only vs Surgical Management of Patients with Lesional Infantile Spasms
Abstract number :
2.286
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2205068
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Avantika Singh, MD – Boston Children's Hospital; Christina Briscoe Abath, MD – Boston Children's Hospital; Aristides Hadjinicolaou, MD – Boston Children's Hospital; Alexandra Santana Almansa, MD – Boston Children's Hospital; Catherine Salussolia, MD – Boston Children's Hospital; Christopher Yuskaitis, MD – Boston Children's Hospital; Jeffrey Bolton, MD – Boston Children's Hospital; Chellamani Harini, MD – Boston Children's Hospital
Rationale: Epilepsy surgery may be offered to patients with pharmacoresistant infantile spasms (IS) with epileptologic lesions, though it remains unclear if there is optimal timing when epilepsy surgery should be offered to patients who remain refractory to medical therapy alone. This study aimed to compare outcomes among lesional IS patients who were managed with medical-therapy alone with those who underwent resective surgery (lobar, multilobar or hemispherectomy).
Methods: We conducted a retrospective single-center case-control study of all IS patients born between 2013-2020. We screened 408 patients, 76 (19%) were found to be eligible candidates for resective epilepsy surgery. Demographic, clinical, imaging, electroencephalographic, and developmental data were collected based on chart review. Engel class 1 (free of disabling seizures) and 2 (rare disabling seizures) were deemed as favorable outcomes.
Results: Among the 76 lesional IS patients (51% male), 19 were excluded due to insufficient data or inadequate length of follow-up (< 12 months). For the remaining 57 patients, median age at spasm-onset was 5 months and median duration of follow-up since spasm-onset was 43 months. Fifty-three percent (n=30) patients were managed medically-only, 18 (60%) were seizure/spasm-free, 12 (40%) had ongoing seizures (including 5 with ongoing spasms). Epilepsy surgery (n=27) performed at median age of 18 months resulted in favorable outcome in 22 (81%). Incomplete resection had poorer seizure outcome (p< 0.05). Hemispherectomy was the most common surgery (60%), followed by lobectomy/lesionectomy (30%), and multilobar resection/disconnection (10%). Seizure outcomes did not vary between early (within 6 months of spasm onset) vs later surgery.
Conclusions: Patients with infantile spasms due to structural abnormalities became seizure free with medical management in over half of cases. For pharmacoresistant lesional IS, epilepsy surgery provided favorable seizure outcome in 81% of patients with significantly better results following complete resection.
Funding: None
Surgery