Journal article
Surgical evaluation in children <3 years of age with drug-resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays
Epilepsia (Copenhagen), Vol.63(1), pp.96-107
01/01/2022
DOI: 10.1111/epi.17124
PMID: 34778945
Abstract
Objective Drug-resistant epilepsy (DRE) occurs at higher rates in children <3 years old. Epilepsy surgery is effective, but rarely utilized in young children despite developmental benefits of early seizure freedom. The present study aims to identify unique patient characteristics and evaluation strategies in children <3 years old who undergo epilepsy surgery evaluation as a means to assess contributors and potential solutions to health care disparities in this group. Methods The Pediatric Epilepsy Research Consortium Epilepsy Surgery Database, a multicentered, cross-sectional collaboration of 21 US pediatric epilepsy centers, collects prospective data on children <18 years of age referred for epilepsy surgery evaluation. We compared patient characteristics, diagnostic utilization, and surgical treatment between children <3 years old and those older undergoing initial presurgical evaluation. We evaluated patient characteristics leading to delayed referral (>1 year) after DRE diagnosis in the very young. Results The cohort included 437 children, of whom 71 (16%) were <3 years of age at referral. Children evaluated before the age of 3 years more commonly had abnormal neurological examinations (p = .002) and daily seizures (p = .001). At least one ancillary test was used in 44% of evaluations. Fifty-nine percent were seizure-free following surgery (n = 34), with 35% undergoing limited focal resections. Children with delayed referrals more often had focal aware (p < .001) seizures and recommendation for palliative surgeries (p < .001). Significance There are relatively few studies of epilepsy surgery in the very young. Surgery is effective, but may be disproportionally offered to those with severe presentations. Relatively low utilization of ancillary testing may contribute to reduced surgical therapy for those without evident lesions on magnetic resonance imaging. Despite this, a sizeable portion of patients have favorable outcome after focal epilepsy surgery resections.
Details
- Title: Subtitle
- Surgical evaluation in children <3 years of age with drug-resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays
- Creators
- Michael Scott Perry - Cook Children's Medical CenterSabrina Shandley - Cook Children's Medical CenterMax Perelman - Doernbecher Children's HospitalRani K. Singh - Levine Children's HospitalLily Wong-Kisiel - Divisions of Child Neurology and Epilepsy Department of Neurology Mayo Clinic College of Medicine Rochester Minnesota USAJoseph Sullivan - UCSF Benioff Children's HospitalErnesto Gonzalez-Giraldo - UCSF Benioff Children's HospitalErin Fedak Romanowski - Univ Michigan, Dept Pediat, Michigan Med, Div Pediat Neurol, Ann Arbor, MI 48109 USANancy A. McNamara - University of Michigan–Ann ArborAhmad Marashly - Seattle Children's HospitalAdam P. Ostendorf - Nationwide Children's HospitalAllyson Alexander - University of Colorado Anschutz Medical CampusKrista Eschbach - Children's Hospital ColoradoJeffrey Bolton - Boston Children's HospitalSteven Wolf - Boston Children's Health PhysiciansPatricia McGoldrick - Boston Children's Health PhysiciansDewi F. Depositario-Cabacar - George Washington UniversityMichael A. Ciliberto - University of IowaSatyanarayana Gedela - Children's Healthcare of AtlantaKumar Sannagowdara - Children's Hospital of WisconsinSamir Karia - University of LouisvilleDaniel W. Shrey - Children's Hospital of Orange CountyPriya Tatachar - Lurie Children's HospitalSrishti Nangia - Cornell CollegeZachary Grinspan - Cornell CollegeShilpa B. Reddy - Monroe Carell Jr. Children's HospitalPatel Shital - Monroe Carell Jr. Children's Hospital at VanderbiltJason Coryell - Doernbecher Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Epilepsia (Copenhagen), Vol.63(1), pp.96-107
- DOI
- 10.1111/epi.17124
- PMID
- 34778945
- NLM abbreviation
- Epilepsia
- ISSN
- 0013-9580
- eISSN
- 1528-1167
- Publisher
- Wiley
- Number of pages
- 12
- Language
- English
- Date published
- 01/01/2022
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984303027002771
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