Surgical evaluation in children <3 years of age with drug-resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays

被引：19

作者：

Perry, Michael Scott ^{[1
]}

Shandley, Sabrina ^{[1
]}

Perelman, Max ^{[2
]}

Singh, Rani K. ^{[3
]}

Wong-Kisiel, Lily ^{[4
,5
]}

Sullivan, Joseph ^{[6
]}

Gonzalez-Giraldo, Ernesto ^{[6
]}

Romanowski, Erin Fedak ^{[7
]}

McNamara, Nancy A. ^{[7
]}

Marashly, Ahmad ^{[8
]}

Ostendorf, Adam P. ^{[9
]}

Alexander, Allyson ^{[10
,11
]}

Eschbach, Krista ^{[12
]}

Bolton, Jeffrey ^{[13
]}

Wolf, Steven ^{[14
]}

McGoldrick, Patricia ^{[14
]}

Depositario-Cabacar, Dewi F. ^{[15
]}

Ciliberto, Michael A. ^{[16
]}

Gedela, Satyanarayana ^{[17
]}

Sannagowdara, Kumar ^{[18
]}

Karia, Samir ^{[19
]}

Shrey, Daniel W. ^{[20
]}

Tatachar, Priya ^{[21
]}

Nangia, Srishti ^{[22
]}

Grinspan, Zachary ^{[22
]}

Reddy, Shilpa B. ^{[23
]}

Shital, Patel ^{[23
]}

Coryell, Jason ^{[2
]}

机构：

[1] Cook Childrens Med Ctr, Justin Neurosci Ctr, Ft Worth, TX USA

[2] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Oregon Hlth Sci Ctr, Portland, OR 97201 USA

[3] Atrium Hlth, Dept Pediat, Div Neurol, Levine Childrens Hosp, Charlotte, NC USA

[4] Mayo Clin, Dept Neurol, Div Child Neurol, Coll Med, Rochester, MN USA

[5] Mayo Clin, Dept Neurol, Div Epilepsy, Coll Med, Rochester, MN USA

[6] Univ Calif San Francisco, San Francisco Weill Inst Neurosci, Benioff Childrens Hosp, San Francisco, CA 94143 USA

[7] Univ Michigan, Dept Pediat, Michigan Med, Div Pediat Neurol, Ann Arbor, MI 48109 USA

[8] Univ Washington, Seattle Childrens Hosp, Div Pediat Neurol, Seattle, WA 98195 USA

[9] Ohio State Univ, Dept Pediat, Nationwide Childrens Hosp, Columbus, OH 43210 USA

[10] Univ Colorado, Dept Neurosurg, Anschutz Med Campus, Aurora, CO USA

[11] Childrens Hosp Colorado, Div Pediat Neurosurg, Aurora, CO USA

[12] Univ Colorado, Dept Neurol, Childrens Hosp Colorado, Anschutz Med Campus, Aurora, CO USA

[13] Boston Childrens Hosp, Dept Neurol, Boston, MA USA

[14] New York Med Coll, Boston Childrens Hlth Phys New York & Connecticut, Maria Fareri Childrens Hosp, Valhalla, NY 10595 USA

[15] George Washington Univ, Sch Med, Childrens Natl Hosp, Ctr Neurosci, Washington, DC USA

[16] Univ Iowa Hosp & Clin, Dept Pediat, Iowa City, IA 52242 USA

[17] Emory Univ, Dept Pediat, Childrens Healthcare Atlanta, Coll Med, Atlanta, GA 30322 USA

[18] Med Coll Wisconsin, Dept Pediat Neurol, Childrens & Lospital Wisconsin, Milwaukee, WI 53226 USA

[19] Univ Louisville, Norton Childrens Hosp, Dept Neurol, Sch Med, Louisville, KY 40292 USA

[20] Childrens Hosp Orange Cty, Orange, CA 92668 USA

[21] Ann & Robert H Lurie Childrens Hosp, Dept Pediat, Chicago, IL USA

[22] Weill Cornell Med, New York, NY USA

[23] Vanderbilt Univ, Dept Pediat Neurol, Monroe Carell Jr Childrens Hosp, 221 Kirkland Hall, Nashville, TN 37235 USA

来源：

EPILEPSIA | 2022年 / 63卷 / 01期

关键词：

childhood epilepsy; epilepsy surgery; pharmacoresistant; SURGERY; ONSET; CLASSIFICATION; OUTCOMES; YOUNGER;

D O I：

10.1111/epi.17124

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：96 / 107

页数：12

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