Drug-resistant children and adolescents that undergo epilepsy surgery have a significantly higher rate of seizure-free periods and better quality of life compared to those who simply continue medical therapy, according to a new study published in the New England Journal of Medicine.  Manjari Tripathi, MD, DM


Researchers led by Manjari Tripathi, MD, DM, professor of neurology at the All India Institute of Medical Sciences in New Delhi, examined how neurosurgical treatment affected seizure rates in 116 children and adolescents with epilepsy. In total, 77% (n = 44) of patients that received the surgery were free from seizures, compared to 7% (n = 4) in the medication group (P <.001).


Over the 12-month period, the cohort was randomized to either the surgery group (n = 57) to undergo brain surgery deemed appropriate for the individual’s underlying cause of epilepsy, or the medical therapy group (n = 59) to receive anti-epileptic drugs. The medical therapy group members were placed on a waitlist for surgery.


At baseline, the majority (84%) of the surgery group experienced ≥1 seizure per day (n = 48), which was mirrored by the medical therapy group (68%, n = 40). Most seizures experienced were focal, with 75% (n = 43) and 73% (n = 43) of patients reporting them in the surgery and medical therapy groups, respectively.


Study authors noted the Kaplan-Meier estimates for the probability of being seizure-free at month 12, with the surgery group recording a 36.7% rate of seizure-free survival compared to 0% for the medical therapy group (hazard ratio [HR] 6.2, 95% CI; 4.6-8.2; P <.001).


The mean Hague Seizure Severity scale score was 37.9 ±4.2 for the surgery group and 37.4 ±4.3 for the medical therapy group, while Pediatric Quality of Life Inventory score means were 53.4 ±15.4 and 53.2 ±16.4, respectively.


At the 12-month mark, the relative risk of seizure recurrence was 4.09 times greater in the medical therapy group (95% CI; 2.52-6.62) compared with the surgery group. The Hague Seizure Severity scale scores at 12 months were 15.4 ±5.5 for the surgery group and 34.3 ±11.8 for the medical therapy group, while the Pediatric Quality of Life Inventory scores were 76.1 ±13.1 and 53.9 ±18.5, respectively.


The surgical group also recorded higher scores on the Binet-Kamat test for intelligence quotient (62.7 ±18.5 compared to 58.9 ±22.1) and the Vineland Social Maturity Scale for social quotient (41.5 ±23.1 compared to 39.9 ±19.7).


Adverse events (AEs) occurred in 12 patients in the medical therapy group. Of the 12, 10 patients experienced physical injuries as a result of seizures, 1 had an AE associated with anti-epileptic medications, and 1 developed autistic features.


Serious AEs occurred in 19 patients (33%) in the surgery group and none in the medical therapy group. Monoparesis occurred in 2 patients who underwent either temporal lobectomy or resection of the parietal focal cortical dysplasia, hemiparesis occurred in 15 patients who underwent hemispherotomy, and generalized hypotonia occurred in 1 patient and language deficits occurred in 1 patient (both underwent frontal lobectomy).

Of the 17 with monoparesis or hemiparesis, 15 were capable of moving all major joints against gravity or better at the 12-month mark. Both the patient with generalized hypotonia and the patient with language deficits reached baseline motor or language function at 12 months.


The study, Surgery for Drug-Resistant Epilepsy in Children, was published in the New England Journal of Medicine October 26, 2017.


Source: Article by M. Hoffman for MDMag.com