Taisuke Otsuki1, Heung-Dong Kim2, Guoming Luan3, Yushi Inoue4, Hiroshi Baba5, Hirokazu Oguni6, Seung-Chyul Hong7, Shigeki Kameyama8, Katsuhiro Kobayashi9, Shinichi Hirose10, Hitoshi Yamamoto11, Shin-ichiro Hamano12, Kenji Sugai13. 1. Epilepsy Center, National Center of Neurology and Psychiatry, Tokyo, Japan. Electronic address: otsukit@ncnp.go.jp. 2. Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea. 3. Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China. 4. National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan. 5. Department of Neurosurgery, National Nagasaki Medical Center, Nagasaki, Japan. 6. Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan. 7. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. 8. Department of Neurosurgery, Nishi-Niigata Chuo National Hospital, Niigata, Japan. 9. Department of Child Neurology, Okayama University Hospital, Okayama, Japan. 10. Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan. 11. Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan. 12. Division of Neurology, Saitama Children's Medical Center, Saitama, Japan. 13. Epilepsy Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
Abstract
OBJECTIVE: To compare the seizure and developmental outcomes in infants and young children with epileptic encephalopathy who have undergone surgical and medical treatments. METHODS: An international, multicenter, observational cohort study was undertaken. A total of 317 children aged <6 years, who had frequent disabling seizures despite intensive medical treatments, were registered. Among the enrolled children, 250 were treated medically (medical group), 31 underwent resective surgery (resective group), and 36 underwent palliative surgery [callosotomy (n=30) or vagal nerve stimulation (n=6); palliative group] on admission. Seizure and developmental outcomes were obtained for 230 children during the 3-year follow-up period. Cox proportional hazard model was used to adjust for clinical backgrounds among treatment groups when comparing the seizure-free survival rates. RESULTS: At the 3-year follow-up, seizure-free survival was 15.7%, 32.1%, and 52.4% in the medical, palliative, and resective groups, respectively. The adjusted hazard ratios for seizure recurrence in the resective and palliative groups versus the medical group were 0.43 (95% CI, 0.21-0.87, P=0.019) and 0.82 (95% CI, 0.46-1.46, P=0.50), respectively; the former was statistically significant. Regarding the developmental outcome, the mean DQs in the resective group increased significantly compared to those in the medical group during the follow-up (P<0.01). As for subgroup analysis, better seizure and development outcomes were demonstrated in the resective group compared to the medical group in children with nonsyndromic epilepsies (those to which no known epilepsy syndromes were applicable). SIGNIFICANCE: These results suggest that surgical treatments, particularly resective surgeries, are associated with better seizure and developmental outcomes compared with successive medical treatment. The present observations may facilitate the identification of infants and young children with epileptic encephalopathy who could benefit from surgery.
OBJECTIVE: To compare the seizure and developmental outcomes in infants and young children with epilepticencephalopathy who have undergone surgical and medical treatments. METHODS: An international, multicenter, observational cohort study was undertaken. A total of 317 children aged <6 years, who had frequent disabling seizures despite intensive medical treatments, were registered. Among the enrolled children, 250 were treated medically (medical group), 31 underwent resective surgery (resective group), and 36 underwent palliative surgery [callosotomy (n=30) or vagal nerve stimulation (n=6); palliative group] on admission. Seizure and developmental outcomes were obtained for 230 children during the 3-year follow-up period. Cox proportional hazard model was used to adjust for clinical backgrounds among treatment groups when comparing the seizure-free survival rates. RESULTS: At the 3-year follow-up, seizure-free survival was 15.7%, 32.1%, and 52.4% in the medical, palliative, and resective groups, respectively. The adjusted hazard ratios for seizure recurrence in the resective and palliative groups versus the medical group were 0.43 (95% CI, 0.21-0.87, P=0.019) and 0.82 (95% CI, 0.46-1.46, P=0.50), respectively; the former was statistically significant. Regarding the developmental outcome, the mean DQs in the resective group increased significantly compared to those in the medical group during the follow-up (P<0.01). As for subgroup analysis, better seizure and development outcomes were demonstrated in the resective group compared to the medical group in children with nonsyndromic epilepsies (those to which no known epilepsy syndromes were applicable). SIGNIFICANCE: These results suggest that surgical treatments, particularly resective surgeries, are associated with better seizure and developmental outcomes compared with successive medical treatment. The present observations may facilitate the identification of infants and young children with epilepticencephalopathy who could benefit from surgery.