The Impact of Presurgical Diagnostic Testing on Surgical Decision Making in Pediatric Mri-negative Drug-resistant Epilepsy
Abstract number :
1.333
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204464
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Dani Esteban, BS – University of North Texas Health Science Center, School of Osteopathic Medicine; Sabrina Shandley, PhD – Justin Neurosciences Center – Cook Children's Medical Center; emily Brock, BS – Cook Children's Medical Center; Shannon Conrad, MS – Cook Children's Medical Center; Allyson Alexander, MD – University of Colorado/Children's Hospital Colorado; krista Eschbach, MD – University of Colorado/Children's Hospital Colorado; Erin fedak Romanowski, MD – Michigan Medicine; Nancy Mcnamara, MD – Michigan Medicine; Lily Wong-Kisiel, MD – Mayo Clinic College of Medicine; Michael Ciliberto, MD – University of Iowa Hospitals and Clinics; Rani Singh, MD – Atrium Health/Levine Children's Hospital; Jason Coryell, MD – Oregon Health and Sciences University/Doernbecher Children's Hospital; Dewi Depositario-Cabacar, MD – George Washington University/Children's National Hospital; Satya Gedela, MD – Emory University College of Medicine/Children's Healthcare of Atlanta; Ernesto Gonzalez-Giraldo, MD – University of California-San Francisco; joseph sullivan, MD – Pediatric Neurology – University of California-San Francisco; Srishti Nangia, MD – Weill-Cornell Medicine; Zachary Grinspan, MD – Weill-Cornell Medicine; Adam Ostendorf, MD – Ohio State University/Nationwide Children's; Samir Karia, MD – University of Louisville School of Medicine/Norton Children's Hospital; Jennifer Koop, PhD – Medical College of Wisconsin/Children's Hospital of Wisconsin; Chad Manuel, MD – Vanderbilt University/Monroe Carell Jr Children's Hospital; Michael McCormack, MD – vanderbilt University/Monroe Carell Jr Children's Hospital; Shilpa Reddy, MD – Vanderbilt University/Monroe Carell Jr Children's Hospital; Ahmad Marashly, MD – Pediatric Neurology – The Johns Hopkins Hospital; joffre Olaya, MD – Pediatric Neurosurgery – Children's Hospital of Orange County; Jeffrey bolton, MD – Boston Children's Hospital; Primyavada Tatachar, MD – Ann and Robert H Lurie Children's Hospital; Steven Wolf, MD – Boston Children's Health Physicians of NY and Connecticut; patricia McGoldrick, MD – Boston Children's Health Physicians of NY and Connecticut; Dallas Armstrong, MD – Pediatric Neurology – University of Texas Southwestern Medical Center; debopam Samanta, MD – Child Neurology – University of Arkansas for Medical Sciences; Michael Perry, MD – Justin Neurosciences Center – Cook Children's Medical Center
This abstract is a recipient of the Grass Young Investigator Award
Rationale: Presurgical evaluation of pediatric MRI-negative drug-resistant epilepsy (DRE) uses multiple imaging modalities, yet our understanding of how testing impacts surgical decision making is limited. We describe the relationship among presurgical imaging method practices, the decision to pursue surgery and seizure freedom.
Methods: The Pediatric Epilepsy Research Consortium Epilepsy Surgery Database is a prospective observational study collecting data on all children 0 to 18 years referred for epilepsy surgery across 24 U.S. pediatric epilepsy centers. For this analysis, we included patients undergoing initial surgical evaluation with a normal MRI and final decision on surgical therapy rendered by their treating institution. Methods of evaluation were at the discretion of the treating facility. Using logistic regression, we compared the relationship of presurgical neuroimaging studies (number and type) to a decision to offer surgery, type of surgery offered (1 stage vs. 2 stage using invasive EEG), and seizure free outcome while controlling for age of seizure onset, duration of epilepsy prior to surgery, seizure frequency, number of seizure types and neurological exam.
Results: A total of 352 patients were included. Baseline patient characteristics are shown in table 1. All patients underwent MRI and video EEG. MRI was 3T in 297 (84%), 1.5T in 27 (7.8%) and uncategorized in the remainder. Thin-slice images were acquired in 321 (91%). Additional testing and surgery was completed as described in Table 2. The odds of being offered surgery increased 1.28 [95% C.I. = 1.02, 1.60] with each additional test included in the presurgical evaluation. The odds of offering surgery increased by 4.08 [95% C.I. = 2.06, 8.09] when SPECT was performed and 3.90 [95% C.I. = 1.72, 8.85] when fMRI was performed. The odds of being offered 2 stage surgery increased by 3.03 [95% C.I. = 2.08, 4.43] with each additional test performed. The odds for 2 stage surgery increased by 10.76 [95% C.I. = 4.71, 24.57] with PET, 2.81 [95% C.I. = 1.41, 5.61] with SPECT, and 5.58 [95% C.I. = 2.32, 13.46] with MEG. The total number of ancillary tests and type of tests included in the evaluation did not impact the chances of seizure freedom after surgery, though a trend in patients evaluated with MEG prior to surgery toward more frequent seizure-free outcome was observed (p = .076).
Conclusions: The likelihood of pursuing epilepsy surgery in MRI-negative DRE increases with each additional neuroimaging test completed. This likely reflects an effort to more accurately localize seizure onset in a recognized surgical candidate. Importantly, the number of presurgical tests performed does not increase the odds of single stage surgery or achieving seizure freedom, underscoring the complexity of these cases. Instead, additional testing is likely acquired in an effort to guide invasive EEG placement. Future research will focus on patient factors that influence the number of studies utilized in evaluation and defining algorithms that lead to superior seizure-free outcomes.
Funding: None
Surgery