Journal article
Associations Between Testing and Treatment Pathways in a Case of Pediatric Nonlesional Epilepsy: A Census Survey of NAEC Center Directors
Journal of child neurology, Vol.40(3), pp.162-167
03/2025
DOI: 10.1177/08830738241288278
PMID: 39449630
Abstract
Epilepsy surgery is vital in managing of children with drug-resistant epilepsy. Noninvasive and invasive testing modalities allow for evaluation and treatment of children with drug-resistant epilepsy. Evidence-based algorithms for this process do not exist. This study examines expert response to a vignette of pediatric nonlesional epilepsy to assess associations in evaluation and treatment choices.OBJECTIVEEpilepsy surgery is vital in managing of children with drug-resistant epilepsy. Noninvasive and invasive testing modalities allow for evaluation and treatment of children with drug-resistant epilepsy. Evidence-based algorithms for this process do not exist. This study examines expert response to a vignette of pediatric nonlesional epilepsy to assess associations in evaluation and treatment choices.We analyzed annual report data and an epilepsy practice survey reported in 2020 from 135 pediatric epilepsy center directors in the United States. Characteristics of centers along with noninvasive and invasive testing and surgical treatment strategies were collected. Multivariable logistic regression modeling was performed.METHODSWe analyzed annual report data and an epilepsy practice survey reported in 2020 from 135 pediatric epilepsy center directors in the United States. Characteristics of centers along with noninvasive and invasive testing and surgical treatment strategies were collected. Multivariable logistic regression modeling was performed.The response rate was 100% with 135 responses included in the analyses. Most used noninvasive testing modalities included Neuropsychology evaluation (90%), interictal brain fluorodeoxyglucose-positron emission tomography (85%), and functional magnetic resonance imaging (MRI) (72%) with nearly half obtaining genetic testing. Choosing functional MRI was associated with stereo electroencephalography (EEG) (P = .025) and selecting Wada with subdural grid/strips (P = .038). Directors from pediatric-only centers were more likely to choose stereo EEG as opposed to combined centers (P = .042). Laser interstitial thermal therapy was almost 7 times as likely to be chosen as a treatment modality compared with open resection in dedicated pediatric centers (OR 6.96, P = .002).RESULTSThe response rate was 100% with 135 responses included in the analyses. Most used noninvasive testing modalities included Neuropsychology evaluation (90%), interictal brain fluorodeoxyglucose-positron emission tomography (85%), and functional magnetic resonance imaging (MRI) (72%) with nearly half obtaining genetic testing. Choosing functional MRI was associated with stereo electroencephalography (EEG) (P = .025) and selecting Wada with subdural grid/strips (P = .038). Directors from pediatric-only centers were more likely to choose stereo EEG as opposed to combined centers (P = .042). Laser interstitial thermal therapy was almost 7 times as likely to be chosen as a treatment modality compared with open resection in dedicated pediatric centers (OR 6.96, P = .002).In a vignette of nonlesional childhood drug-resistant epilepsy, epilepsy center directors' patterns of noninvasive testing, invasive testing, and treatment were examined. Management choices were associated with pediatric versus combined pediatric/adult center characteristics. Expert opinions demonstrated equipoise in evaluation and management of children with drug-resistant epilepsy and the need for evidence-based management strategies.SIGNIFICANCEIn a vignette of nonlesional childhood drug-resistant epilepsy, epilepsy center directors' patterns of noninvasive testing, invasive testing, and treatment were examined. Management choices were associated with pediatric versus combined pediatric/adult center characteristics. Expert opinions demonstrated equipoise in evaluation and management of children with drug-resistant epilepsy and the need for evidence-based management strategies.
Details
- Title: Subtitle
- Associations Between Testing and Treatment Pathways in a Case of Pediatric Nonlesional Epilepsy: A Census Survey of NAEC Center Directors
- Creators
- Christopher W Beatty - Nationwide Children's HospitalStephanie M Ahrens - Nationwide Children's HospitalKristen H Arredondo - The University of Texas at AustinAnto I Bagic - University of PittsburghShasha Bai - Emory UniversityKevin E Chapman - Phoenix Children's HospitalMichael A Ciliberto - University of IowaDave F Clarke - The University of Texas at AustinMariah Eisner - Nationwide Children's HospitalNathan B Fountain - University of VirginiaJay R Gavvala - Baylor College of MedicineM S Perry - Cook Children's Medical CenterKyle C Rossi - Beth Israel Deaconess Medical CenterLily C Wong-Kisiel - Mayo ClinicSusan T Herman - Barrow Neurological InstituteAdam P Ostendorf - Nationwide Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of child neurology, Vol.40(3), pp.162-167
- Publisher
- Sage
- DOI
- 10.1177/08830738241288278
- PMID
- 39449630
- ISSN
- 1708-8283
- eISSN
- 1708-8283
- Grant note
- Nationwide Children's Hospital: 45141-0001-0321 National Association of Epilepsy Centers: 810712-1221-00
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Award Number 45141-0001-0321 from Nationwide Children's Hospital and Award Number 810712-1221-00 from the National Association of Epilepsy Centers.
- Language
- English
- Electronic publication date
- 10/25/2024
- Date published
- 03/2025
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984738441502771
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