Number of epilepsy surgeries has decreased despite an increase in pre-surgical evaluations at a tertiary pediatric epilepsy center in Ontario

Omar Yossofzai; Asthik Biswas; Rahim Moineddin; George M Ibrahim; James Rutka; Elizabeth Donner; Carter Snead; Nicholas Mitsakakis; Elysa Widjaja

doi:10.1016/j.seizure.2023.04.001

Number of epilepsy surgeries has decreased despite an increase in pre-surgical evaluations at a tertiary pediatric epilepsy center in Ontario

Seizure. 2023 May:108:1-9. doi: 10.1016/j.seizure.2023.04.001. Epub 2023 Apr 3.

Authors

Omar Yossofzai¹, Asthik Biswas², Rahim Moineddin³, George M Ibrahim⁴, James Rutka⁴, Elizabeth Donner⁵, Carter Snead⁵, Nicholas Mitsakakis⁶, Elysa Widjaja⁷

Affiliations

¹ Institute of Medical Science, University of Toronto, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, Canada.
² Department of Diagnostic Imaging, The Hospital for Sick Children, Canada.
³ Department of Family and Community Medicine, University of Toronto, Canada.
⁴ Department of Neurosurgery, The Hospital for Sick Children, Canada.
⁵ Division of Neurology, The Hospital for Sick Children, Canada.
⁶ Children's Hospital of Eastern Ontario Research Institute, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
⁷ Department of Diagnostic Imaging, The Hospital for Sick Children, Canada; Division of Neurology, The Hospital for Sick Children, Canada; Department of Medical Imaging, Lurie Children's Hospital of Chicago, United States. Electronic address: ewidjaja@luriechildrens.org.

PMID: 37059033
DOI: 10.1016/j.seizure.2023.04.001

Abstract

Objective: A recent U.S. study reported that the number of epilepsy surgeries has remained stable or declined in recent years despite an increase in pre-surgical evaluation. This study aimed to evaluate trends in pre-surgical evaluation and epilepsy surgery from 2001 to 2019 and to determine whether these trends have changed in the later period (2014-2019) compared to earlier period (2001-2013).

Methods: This study evaluated trends in pre-surgical evaluation and epilepsy surgery at a tertiary pediatric epilepsy center. Children with drug resistant epilepsy who were evaluated for surgery were included. Clinical data, reasons for not undergoing surgery, and surgical characteristics of surgery patients were collected. Overall trends and trends in later period compared to earlier period for pre-surgical evaluation and epilepsy surgery were assessed.

Results: There were 1151 children who were evaluated for epilepsy surgery and 546 underwent surgery. There was an upward trend in pre-surgical evaluation in the earlier period (rate ratio [RR]=1.04 (95%CI:1.02-1.07), p<0.001) and the trajectory of presurgical evaluation in the later period was not significantly different to the earlier period (RR=1.00 [95%CI:0.95-1.06], p = 0.88). Among the reasons for not undergoing surgery, failure to localize the seizures occurred more frequently in later period than earlier period (22.6% vs. 17.1% respectively, p = 0.024). For number of surgeries, there was an upward trend between 2001 and 2013 (RR=1.08 [95%CI:1.05-1.11], p<0.001), and a decreasing trend in the later period compared to earlier period (RR=0.91 [95%CI:0.84-0.99], p = 0.029).

Conclusion: Despite an increasing trend in pre-surgical evaluation, there was a decreasing trend in the number of epilepsy surgery in the later period as there was a larger proportion of patients in whom the seizures could not be localized. Trends in presurgical evaluation and epilepsy surgery will continue to evolve with introduction of technologies such as stereo-EEG and minimally invasive laser therapy.

Keywords: Drug resistant epilepsy; Epilepsy trends; Pediatric epilepsy surgery; Presurgical evaluation; Seizure outcome.

MeSH terms

Child
Drug Resistant Epilepsy* / surgery
Electroencephalography
Epilepsy* / surgery
Humans
Ontario
Retrospective Studies
Treatment Outcome