Associate Professor of Neurology Mayo Clinic Rochester Rochester, Minnesota
This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session This abstract will be presented during a Pediatric Highlights platform poster session
Rationale: Scalp video EEG monitoring and MRI findings direct the need for additional localizing modalities to recommend epilepsy surgery. Noninvasive presurgical evaluations are dependent on the resources and expertise of individual centers. In a multicenter pediatric epilepsy surgery database, we evaluated the utilization of diagnostic modalities in children with refractory epilepsy undergoing surgical evaluation. Methods: Nineteen pediatric epilepsy centers in the United States prospectively enrolled patients 0-18 years of age undergoing epilepsy surgery evaluation between January 1, 2018 and June 13, 2020 as part of the Pediatric Epilepsy Research Consortium Epilepsy Surgery Project. Variables included patient demographics, epilepsy characteristics, presurgical treatment, evaluation, and opinions regarding epilepsy surgery from multidisciplinary epilepsy surgery conferences. Congruency of a diagnostic evaluation was defined as localizing within the same hemisphere as the EEG localization. Wilcoxon rank sum test compared continuous data. A Chi-Square test assessed association of categorical data. Results: Consensus opinions regarding epilepsy surgery were available for 492 patients with the following recommendations: no surgery for 21%, one-stage surgery for 43%, and further invasive monitoring for 35%. Video EEG showed a single ictal localization with congruent MRI abnormality in 41%. Consensus opinion was rendered after video EEG and MRI in 35%, after one additional modality in 33%, and after two or more modalities in 32%. FDG-PET was performed in 56%, peri-ictal SPECT in 26%, and MEG dipole cluster analysis in 21%. Compared to those who underwent additional evaluations, children who received a surgical recommendation after video EEG and MRI alone had a younger age of onset (2.9 (IQR 0.5-7) years vs. 4.5 (IQR 1-9.1) years, p< 0.05), were more likely to have abnormal MRI (87% vs. 74%, p< 0.05), and were less likely to receive a recommendation for invasive monitoring (15% vs. 46%, p< 0.0001). Sex, race, ethnicity, age of referral, duration of epilepsy, or discordance between MRI abnormality and EEG localization did not contribute to number of additional evaluations (Table). Congruency with video EEG lateralization was in seen in 303/383 (79%) patients with abnormal MRI, 201/275 (73%) patients with PET, 75/105 (71%) patients with MEG dipoles, and 58/130 (45%) patients with peri-ictal SPECT. Conclusions: In this prospective multicenter cohort of children undergoing epilepsy surgery evaluation in the United States, the majority of patients underwent additional localizing evaluations beyond video EEG and MRI brain. One-third of the patients had one additional localizing modality and another third received two or more additional localizing evaluations. FDG-PET was the most common modality used. Opinions regarding epilepsy surgery were rendered after video EEG and MRI without additional evaluations in younger patients and those with abnormal MRI. Additional diagnostic evaluations were associated with recommendation for invasive monitoring. Funding: Please list any funding that was received in support of this abstract.: none Click here to view image/table
