Aug 2026· Epilepsy Research· Vol 227, pp.
107895
· 0 citations· 16 references
Medicine
TL;DR
The ESC panels were most accurate in predicting seizure freedom at the extremes of the predicted probability spectrum and performed similarly to the SFS.
Abstract
There is a paucity of data assessing the accuracy of clinician prognostication for pediatric epilepsy surgery outcomes during multidisciplinary epilepsy surgery conferences (ESCs). This cross-sectional study, completed at Children's Hospital of Colorado (CHCO) and Children's Health Dallas (CHD), compared seizure freedom predictions by the ESC panels (captured via anonymous surveys of ESC members) to estimated outcomes by the Seizure Freedom Score (SFS) and to observed post-operative seizure freedom rates. The sample comprised 20 patients from CHCO (12/2021 - 12/2022) and 10 patients from CHD (6/2022-12/2023) satisfying inclusion criteria of at least 9 months of follow-up and survey completion by ≥ 50% of the ESC panels. Six patients were excluded from ESC prediction analysis for lack of consensus in their predicted prognoses. Predicted seizure freedom probabilities were assigned in ranges. The ESC panels accurately predicted seizure freedom for 80% (n = 8/10) of children for whom they had assigned higher predictive probabilities. Most of these children had known lesions and concordant presurgical data. ESC physicians accurately predicted lack of seizure freedom for 75% (n = 3/4) of children for whom they assigned lower predictive probabilities for seizure freedom. However, for the intermediate probabilities of 50-69%, 27% (n = 3/11) of children achieved seizure freedom. The SFS (scores 3-4) accurately predicted seizure freedom for 69% (n = 9/13) of patients. The ESC panels were most accurate in predicting seizure freedom at the extremes of the predicted probability spectrum and performed similarly to the SFS.
Similar children evaluated at different institutions had significant differences in the odds of not being recommended surgery, suggesting that institutional decision-making contributes importantly to surgical candidacy.
A. Caraway, Nancy A. Mcnamara, Andrew T. Knox et al.· Epilepsia· 0 citations
Overall, the presence of SCSs alone was not associated with a poor outcome, but the spatial non-concordance with the seizure-onset zone was highly predictive for poor seizure outcome.
P. Bosque-Varela, Panagiota-Eleni Tsalouchidou, Petra Levicka et al.· Epilepsia· 0 citations
BACKGROUND AND OBJECTIVES: Of 50 million people with epilepsy globally, up to 10 million with lesional drug resistance epilepsy may be able to achieve seizure control with surgical options. Although multidisciplinary surgical care for epilepsy is available in high-income countries, few programs exist in low- and middle-income countries (LMICs). In 2019, a global collaboration between CURE Uganda and Ann & Robert H. Lurie Children's Hospital in the United States established a surgical epilepsy program in Uganda for the pediatric population. This study identifies key pillars for sustainable neurosurgical program development in LMICs. METHODS: Interdisciplinary health care providers from CURE and Lurie Children's who participated in the development of the surgical epilepsy program from 2019 to 2024 underwent semistructured qualitative interviews. A thematic analysis framework was used to identify themes from interviews related to program development, sustainability, and targets for future work. RESULTS: Nine participants were interviewed, with representation from roles of pediatric neurologist, pediatric neuroradiologist, electroencephalogram technologists, medical officer, and pediatric neurosurgeon. Thematic analysis revealed 4 themes (with subthemes) related to sustainable global surgical program development: (1) Intentional planning (integrating global policies into program development, rigorous case selection for great outcomes to build confidence for public/administrative support, defining barriers and optimizing solutions); (2) interdisciplinary collaboration (communication and trust are vital, new initiatives may require sacrifice, true partnerships allow for bidirectional learning, creative problem solving is crucial); (3) skill transfer and education (on-the-ground skill transfer needed, technology integration facilitates continuous learning, enable development opportunities for teammates); and (4) targets for future work (public education, expanding clinical capacity in LMICs, sustainable education centers, research dissemination). CONCLUSION: Global collaborations create opportunities to increase access to neurosurgical care. Creating interdisciplinary programs across borders requires trust and open communication by all members. Sustainable programs can be further enabled with intentional planning, humility, and bidirectional skill transfer.
Rya Muller, Omolabake O. Oyetayo, E. Wegoye et al.· Neurosurgery practice· 0 citations
BACKGROUND
Excess mortality has been demonstrated in individuals with epilepsy. Here, we aimed to examine mortality in patients from two independent First Seizure Clinics (FSCs), up to 20 years after a new epilepsy/unprovoked seizure diagnosis assigned by epileptologists. Patients were also grouped according to pre-existing medical conditions and mortality in these subgroups was examined.
METHODS
In this observational study, adults (≥18 years) diagnosed with epilepsy/unprovoked seizures between 2000-2010 at Austin Health and Royal Melbourne Hospital FSCs were included. FSC information regarding epilepsy and pre-existing conditions (alcohol/substance use, psychiatric disorders, cancer, cardiac and neurological) was audited and linked to the Australian National Death Index. Patient deaths were compared to population age, sex and year-specific death rates with Standardized Mortality Ratios (SMR).
RESULTS
Among N = 1545 diagnosed with epilepsy/unprovoked seizures (excluding high-grade brain tumors), 282 (18%) had deceased (all-cause mortality SMR 2.0; 95%CI 1.8-2.3). Excess mortality to 15 years post-diagnosis was demonstrated at both independent FSCs. For the n = 1375 with information about pre-existing conditions, the SMR was higher for patients with ≥ 1 pre-existing condition (n = 593; 2.6, 95%CI 2.2-3.0) than for those without (n = 782; SMR 1.4, 95%CI 1.1-1.8). Among patient subgroups, reported problematic substance use (±a psychiatric disorder, n = 227) had the highest SMR (5.8; 95%CI 4.5-7.6).
CONCLUSION
Both FSCs demonstrate persistent excess mortality after a new epilepsy diagnosis. Patients who report a history of previous medical conditions, particularly those with problematic alcohol/substance use are potentially important risk groups and warrant further examination. These findings contribute to patient counselling, and inform further investigation.
A. McIntosh, Patrick W. Carney, Meng K. Tan et al.· Epilepsy & Behavior· 0 citations
It is found that the association between early epilepsy surgery and seizure reduction in palliative procedures reflects the heterogeneity of the population, including different types of surgical procedures and lesional and nonlesional epilepsies.
Robert M Crutcher, David E. Horvat, A. Caraway et al.· Epilepsia· 0 citations
Abstract Objective To evaluate the management practices of Infantile Epileptic Spasms Syndrome (IESS) across tertiary pediatric hospitals in the United States using a survey‐based approach. Methods A 21‐question survey focused on management setting, work‐up, follow‐up and treatment was created and sent to 45 member institutions of the Pediatric Epilepsy Research Consortium (PERC). Results were analyzed by a working group of PERC focused on IESS. Results Thirty‐three institutions completed the survey. Most institutions (91%) managed new‐onset IESS in‐patient, with 76% using overnight video EEG (vEEG) monitoring for diagnosis. Nearly all (> 90%) obtained an MRI brain and genetic testing at initial diagnosis. The most common modalities of genetic evaluation were an epilepsy panel (47%) and trio whole exome sequencing (44%). For assessment of response at the first follow‐up, 45% used extended vEEG (1–6 h), with 36% continuing to obtain overnight vEEG. The 2021 BASED score (Burden of Amplitude and Epileptiform Discharges) was the preferred method of assessing response (58%) compared to resolution of hypsarrhythmia (39%). High‐dose prednisolone was the first treatment for most institutions, irrespective of the etiology (apart from Tuberous Sclerosis Complex). Combined treatment (hormonal + vigabatrin) was less commonly used as first treatment (9%–12%, depending on etiology). Most institutions (63%) looked for failure of both hormonal therapy and vigabatrin (sequential or combined) before pursuing surgical treatment in patients with identifiable brain MRI lesions, but would also consider surgical treatment in patients with remission of electro‐clinical epileptic spasms but continued epileptiform EEGs. Significance There are areas of consensus and variability in management of IESS in US institutions. Updated consensus guidelines addressing the comprehensive management of IESS are needed to help standardize and optimize care in these patients. Plain Language Summary Infantile Epileptic Spasms Syndrome requires prompt diagnosis and initiation of appropriate treatment to improve developmental outcomes. In this survey of tertiary pediatric centers in the United States, we found areas of consensus (use of overnight video EEG at initial diagnosis, use of high‐dose prednisolone as initial treatment, preference for sequential as opposed to combination therapy, use of the 2021 BASED score for EEG evaluation, and the early consideration of epilepsy surgery) and variability (type of genetic testing for diagnosis, choice of second and third treatments, use of antiseizure medications for persistently epileptic EEG) in management of these patients.
Akshat Katyayan, Christina Briscoe, Sonam Bhalla et al.· Epilepsia Open· 0 citations
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