(794) Initial vs. repeat epilepsy surgery evaluation for children in the US: Findings from the PERC (Pediatric Epilepsy Research Consortium) Epilepsy Surgery Subgroup
Rationale: Epilepsy surgery can result in seizure freedom for children with drug resistant epilepsy (DRE) and should be considered in appropriate candidates. However, a proportion of patients will have inadequate seizure control after surgery and undergo additional surgical evaluation and treatment. We sought to characterize children undergoing repeat surgical evaluations and compare their epilepsy characteristics, evaluations, and surgical treatment to those undergoing initial evaluations. Methods: We prospectively enrolled patients 0-18 years of age undergoing epilepsy surgery evaluation at 19 pediatric epilepsy centers from the PERC (Pediatric Epilepsy Research Consortium) Epilepsy Surgery Database. Predefined variables collected included demographics, epilepsy characteristics, presurgical treatment, evaluation, surgical therapy, and outcome of epilepsy surgery. Data was analyzed from project inception (1/1/18) to 6/15/20. Patients were grouped by 1) initial or 2) repeat surgical evaluation after failed procedure. Independent t test and Fischer’s exact test were used to compare continuous and categorical variables, respectively. Results: Of 473 patients undergoing presurgical evaluation, 74 (16%) had a previously failed epilepsy surgery. Compared to children undergoing a first presurgical evaluation, children undergoing a repeat evaluation had failed more ASMs (antiseizure medications) [mean 4.6 vs. 3.1], had a younger age of epilepsy onset [mean 4.2 vs. 5.2 years], were more likely to have a structural etiology (76% vs. 60%), were less likely to have an unknown etiology (9% vs 26%), and lived closer to the treating hospital. There were no differences in sex, race, ethnicity, or insurance type (Table 1). MEG scans were more commonly utilized in repeat evaluations (p=0.0401), though there was no difference in VEEG duration or utilization of PET, SPECT, fMRI or neuropsychological testing between the groups. 372 (79%) patients were offered surgical therapy and 265 of these (71%) have completed surgery. There was no difference in likelihood to offer surgery or type of surgery offered (1-stage vs. 2-stage). Outcome data is available for 222 (84%) patients (median follow up seven months). Favorable outcome (Engel 1 or 2) was more common after initial surgery (p=0.016) (Table 2). Conclusions: While repeat epilepsy surgeries in children are less likely to result in seizure freedom, over 50% will experience meaningful ( >90%) seizure reduction. Repeat surgical evaluations are pursued more commonly in children with younger age at seizure onset and structural etiologies, likely related to challenges in completely characterizing the epileptogenic zone in these circumstances. Methods of repeat evaluation more often include MEG, possibly due to difficulties interpreting other neuroimaging in the setting of prior resection. Children undergoing repeat surgical evaluations live closer to surgical centers, suggesting there may be missed opportunities for subsequent evaluation after surgical failure in children without convenient access to surgical centers. Funding: Please list any funding that was received in support of this abstract.: None Click here to view image/table
