Journal article
Associations between testing and treatment pathways in lesional temporal or extratemporal epilepsy: A census survey of NAEC center directors
Epilepsia (Copenhagen), Vol.64(4), pp.821-830
04/2023
DOI: 10.1111/epi.17512
PMID: 36654194
Abstract
The evaluation to determine candidacy and treatment for epilepsy surgery in persons with drug-resistant epilepsy (DRE) is not uniform. Many non-invasive and invasive tests are available to ascertain an appropriate treatment strategy. This study examines expert response to clinical vignettes of MRI-positive lesional focal cortical dysplasia in both temporal and extratemporal epilepsy to identify associations in evaluations and treatment choice.
We analyzed annual report data and a supplemental epilepsy practice survey reported in 2020 from 206 adult and 136 pediatric epilepsy center directors in the United States. Non-invasive and invasive testing and surgical treatment strategies were compiled for the two scenarios. We used chi-square tests to compare testing utilization between the two scenarios. Multivariable logistic regression modeling was performed to assess associations between variables.
The supplemental survey response rate was 100% with 342 responses included in the analyses. Differing testing and treatment approaches were noted between the temporal and extratemporal scenarios such as chronic invasive monitoring selected in 60% of the temporal scenario versus 93% of the extratemporal scenario. Open resection was the most common treatment choice, however overall treatment choices varied significantly (p<0.001). Associations between non-invasive testing, invasive testing, and treatment choices were present in both scenarios. For example, in the temporal scenario SEEG was more commonly associated with FDG-PET (OR 1.85; 95% CI 1.06-3.29; p=0.033), MEG (OR 2.90; 95% CI 1.60-5.28; p = <0.001), HD EEG (OR 2.80; 95% CI 1.27-6.24; p = 0.011), fMRI (OR 2.17; 95% CI 1.19-4.10; p = 0.014) and Wada (OR 2.16; 95% CI 1.28-3.66; p = 0.004). In the extratemporal scenario, choosing SEEG was associated with increased odds of neuromodulation over open resection (OR 3.13; 95% CI 1.24-7.89; p=0.016).
In clinical vignettes of temporal and extratemporal lesional DRE, epilepsy center directors displayed varying patterns of non-invasive testing, invasive testing, and treatment choices. Differences in practice underscore the need for comparative trials for the surgical management of DRE.
Details
- Title: Subtitle
- Associations between testing and treatment pathways in lesional temporal or extratemporal 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 Bagić - 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 HospitalNAEC Center Director Study Group
- Resource Type
- Journal article
- Publication Details
- Epilepsia (Copenhagen), Vol.64(4), pp.821-830
- DOI
- 10.1111/epi.17512
- PMID
- 36654194
- NLM abbreviation
- Epilepsia
- ISSN
- 0013-9580
- eISSN
- 1528-1167
- Language
- English
- Electronic publication date
- 01/18/2023
- Date published
- 04/2023
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984361599502771
Metrics
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