Treatment Odyssey to Epilepsy Surgery in Children with Focal Cortical Dysplasia: Risk Factors for Delayed Surgical Intervention
Abstract number :
1.332
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
1271
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Yoko Takahashi, MD, PhD – National Center of Neurology and Psychiatry
Shimpei Baba, MD, PhD – National Center of Neurology and Psychiatry
Takahiro Kawashima, PhD – National Center of Neurology and Psychiatry
Hisateru Tachimori, PhD – National Center of Neurology and Psychiatry
Keiya Iijima, MD, PhD – National Center of Neurology and Psychiatry
Yuiko Kimura, MD, PhD – National Center of Neurology and Psychiatry
Takashi Saitoh, MD – National Center of Neurology and Psychiatry
Eiji Nakagawa, MD, PhD – National Center of Neurology and Psychiatry
Hirofumi Komaki, MD, PhD – National Center of Neurology and Psychiatry
Masaki Iwasaki, MD, PhD – National Center of Neurology and Psychiatry
Rationale: Despite the unequivocal recommendations for early epilepsy surgery in pediatric patients with drug-resistant epilepsy (DRE), the gap in epilepsy treatment remains a significant global issue. To date, there has been a lack of research investigating surgical delays, specifically in pediatric patients with focal cortical dysplasia (FCD), despite being the most common and favorable candidates for epilepsy surgery. This study aimed to elucidate patient journey to epilepsy surgery and identify the risk factors contributing to surgical delay in pediatric patients with DRE with FCD.
Methods: A retrospective review was conducted of 93 pediatric patients who underwent curative epilepsy surgery for FCD between January 2012 and March 2023 at National Center of Neurology and Psychiatry, a tertiary epilepsy center in Japan. The Odyssey plot demonstrated the treatment process before epilepsy surgery, including key milestones of epilepsy onset, first hospital visit, epilepsy diagnosis, MRI diagnosis, DRE diagnosis and surgery. The primary outcome was surgical delay; the duration from DRE to surgery. Multivariate linear regression models were used to examine the association between surgical delay and clinical, investigative, and treatment characteristics.
Results: The median age at seizure onset was 1.3 years (interquartile range [IQR] 0.14-3.1), and at the time of surgery, it was 6 years (range 1-11). Notably, 46% experienced prolonged surgical delays exceeding two years. The Odyssey plot visually highlighted that surgical delay comprised a significant portion of the patient journey. Although most patients underwent MRI before referral, MRI abnormalities were identified before referral only in 39% of the prolonged surgical group, compared in 70% of the non-prolonged group (p = 0.003). The duration from DRE to MRI abnormality and from the first MRI scan to the MRI abnormality were significantly longer in the prolonged surgical group. Multivariate analyses showed that delayed notification of MRI abnormalities, longer duration from epilepsy onset to DRE, older age at onset, number of antiseizure medications tried, and moderate to severe intellectual disability were significantly associated with prolonged surgical delay.
Conclusions: Our unique treatment odyssey plot revealed that pediatric DRE patients with FCD experienced a long journey until surgery. Early and accurate identification of MRI abnormalities is important to minimize surgical delays.
Funding: None
Clinical Epilepsy