Epilepsy Surgery in Children with Genetic Etiologies: A Prospective Evaluation of Current Practices and Outcomes
AUTHORS
Jason Coryell 1, Rani Singh 2, Adam P Ostendorf 3, Mariah Eisner 4, Allyson Alexander 5, Krista Eschbach 6, Daniel W Shrey 7, Joffre Olaya 7, Michael A Ciliberto 8, Cemal Karakas 9, Samir Karia 9, Nancy McNamara 10, Erin Fedak Romanowski 10, Ammar Kheder 11, Javarayee Pradeep 12, Shilpa B Reddy 13, Michael J McCormack 13, Jeffrey Bolton 14, Steven Wolf 15, Patricia McGoldrick 15, Jason S Hauptman 16, Debopam Samanta 17, Priya Tatachar 18, Joseph Sullivan 19, Kurtis Auguste 19, Ernesto Gonzalez-Giraldo 19, Ahmad Marashly 20, Dewi F Depositario-Cabacar 21, Lily C Wong-Kisiel 22, Scott Perry 23
ABSTRACT
Objective: This study assesses current practices and outcomes of epilepsy surgery in children with a genetic etiology. It explores the pre-surgical workup, types of surgeries, and post-surgical outcomes in a broad array of disorders.
Methods: Patients ≤18 years who completed epilepsy surgery and had a known genetic etiology prior to surgical intervention were extrapolated from the Pediatric Epilepsy Research Consortium (PERC) surgery database, across 18 US centers. Data were assessed univariably by neuroimaging and EEG results, genetic group (structural gene, other gene, chromosomal), and curative intent. Outcomes were based on a modified International League Against Epilepsy (ILAE) outcome score.
Results: Of 81 children with genetic epilepsy, 72 % had daily seizures when referred for surgery evaluation, which occurred a median of 2.2 years (IQR 0.3, 5.2) after developing drug resistance. Following surgery, 68 % of subjects had >50 % seizure reduction, with 33 % achieving seizure freedom [median follow-up 11 months (IQR 6, 17). Seizure freedom was most common in the monogenic structural group, but significant palliation was present across all groups. Presence of a single EEG focus was associated with a greater likelihood of seizure freedom (p=0.02).
Significance: There are meaningful seizure reductions following epilepsy surgery in the majority of children with a genetic etiology, even in the absence of a single structural lesion and across a broad spectrum of genetic causes. These findings highlight the need for expedited referral for epilepsy surgery and support of a broadened view of which children may benefit from epilepsy surgery, even when the intent is palliative.