Epilepsy surgery adds several years to the life expectancy of children with refractory epilepsy who are deemed suitable surgical candidates, and it may improve their quality of life compared with continuing medical therapy only, a new study suggests.
While there’s a growing consensus that surgery is sometimes an optimal choice in some pediatric patients, the new research actually quantifies the benefits, said lead researcher, Iván Sánchez Fernández, MD, an epilepsy fellow in the Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Massachusetts.
“Our model quantifies how this translates in terms of life expectancy, and the quantification shows that epilepsy surgery provides, in general, approximately 5 years of extra life expectancy when compared to medical management only.”
Unfortunately, many children who are surgical candidates still continue to be maintained for years on medical treatment only, he said.
The research was presented here at the 43rd Annual Child Neurology Society Meeting.
Decision Analysis
To compare surgical intervention with continued medical therapy only, researchers collected published articles that evaluated the different factors that contribute to life expectancy in the pediatric refractory epilepsy population. They then developed a decision analysis model that considers all factors contributing to life expectancy.
“This includes mortality in the general population, mortality in seizure-free patients, mortality in patients with refractory epilepsy, perioperative mortality, and perioperative complications, among other factors,” said Dr Sánchez Fernández.
They found that epilepsy surgery yielded a higher life expectancy than only medical treatment. For a cohort of 10-year-old children with refractory epilepsy, the gain in life expectancy with surgery was 5.9 years for temporal lobe epilepsy and 5.6 years for extratemporal epilepsy.
A sensitivity analysis showed that medical management only would be the preferred strategy only under very particular circumstances in which several factors are highly skewed against surgery: for example, very high perioperative risks and low probability of becoming seizure free with surgery.
Dr Sánchez Fernández stressed that the study was based on information already available in the literature. “We have not collected new data for this model.”
Quality of Life
The researchers didn’t attempt to quantify quality of life in children with epilepsy who had surgery or are maintained on medical treatment. As Dr Sánchez Fernández explained, this would require the estimation of utilities, a measure of how much a person values his or her life in their present state compared to a state of perfect health. Utility measures, he said, are frequently used in decision analyses.
However, the researchers did something similar; they estimated the proportion of life expectancy spent in seizure freedom. For a cohort of 10-year-old patients with refractory temporal epilepsy, surgery yielded 48.9% of life expectancy years in seizure freedom while medical treatment yielded 14.3%.
For those with extratemporal epilepsy, surgery yielded 43.0% of life expectancy years in seizure freedom vs 14.3% with medical treatment.
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