Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood

Amy Ka; Amir Taher; Stephanie D'Souza; Elizabeth H Barnes; Sachin Gupta; Christopher Troedson; Fiona Wade; Olga Teo; Russell C Dale; Chong Wong; Andrew F Bleasel; Mark Dexter; Kavitha Kothur; Deepak Gill

doi:10.1016/j.ebr.2022.100561

Predictors of longitudinal seizure outcomes after epilepsy surgery in childhood

Epilepsy Behav Rep. 2022 Jul 8:19:100561. doi: 10.1016/j.ebr.2022.100561. eCollection 2022.

Authors

Amy Ka¹, Amir Taher², Stephanie D'Souza², Elizabeth H Barnes³, Sachin Gupta¹, Christopher Troedson¹, Fiona Wade¹, Olga Teo¹, Russell C Dale^{1

2

4}, Chong Wong⁵, Andrew F Bleasel⁵, Mark Dexter^{1

5}, Kavitha Kothur^{1

2

4}, Deepak Gill^{1

2

4}

Affiliations

¹ TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia.
² University of Sydney, The Children's Hospital at Westmead, Westmead, Sydney, NSW, Australia.
³ NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney.
⁴ Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁵ Department of Neurology, Westmead Hospital, Westmead, Sydney, Australia.

Abstract

There is a paucity of data on longitudinal seizure outcome of children undergoing epilepsy surgery. All children (n = 132) who underwent resective epilepsy surgery from January 1998 to December 2015 were identified. Relevant clinical, neurophysiological, imaging, surgical and seizure outcome data were extracted. Multivariable logistic regression analysis and Kaplan-Meier survival with Cox proportional hazard modelling were performed. The mean age at surgery was 7.8 years (range 0.2-17.9). 71% were seizure-free at a mean follow up of 5.3 ± 2.7 years. Of those who were seizure-free, 65 patients were able to completely wean off anti- seizure medications successfully. Using survival analysis, the probability of Engel Class I outcome at one year after surgery was 81% (95% confidence interval [CI] 87%-75%). This dropped to 73% at two years (95% CI 81%-65%), 58% at five years (95% CI 67.8%-48%), and 47% at ten years. Proportional hazard modelling showed that the presence of moderate to severe developmental disability (HR 6.5; p = 0.02) and lack of complete resection (HR 0.4; p = 0.02) maintain association as negative predictors of seizure-free outcome. Our study demonstrates favorable long-term seizure control following pediatric epilepsy surgery and highlights important predictors of seizure outcome guiding case selection and counseling of expectations prior to surgery.

Keywords: ASM, Anti seizure medication; DEE, Developmental epileptic encephalopathy; ECoG, Electrocorticography; EEG, Electro encephalogram; Epilepsy; Epilepsy surgery; FCD, Focal cortical dysplasia; FDG-PET, Fluorodeoxyglucose positron emission tomography; Focal cortical dysplasia; MRI, Magnetic Resonance Imaging; SPECT, Single-photon emission computed tomography; Tumours.