Carmen Barba1, Massimo Cossu2, Renzo Guerrini1,3, Giancarlo Di Gennaro4, Flavio Villani5,6, Luca De Palma7, Laura Grisotto8, Alessandro Consales9, Domenica Battaglia10, Nelia Zamponi11, Piergiorgio d'Orio2,12, Martina Revay2, Michele Rizzi2, Sara Casciato4, Vincenzo Esposito4,13, Pier Paolo Quarato4, Roberta Di Giacomo5, Giuseppe Didato5, Chiara Pastori5, Giusy Carfi Pavia7, Simona Pellacani1, Giulia Matta1, Mattia Pacetti9, Gianpiero Tamburrini14, Elisabetta Cesaroni11, Gabriella Colicchio15, Giampaolo Vatti16, Sofia Asioli17, Massimo Caulo18, Carlo Efisio Marras7, Laura Tassi2. 1. Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy. 2. "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy. 3. IRCCS Stella Maris, Pisa, Italy. 4. IRCCS Neuromed, Pozzilli, Italy. 5. Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy. 6. Division of Neurophysiology and Epilepsy Centre, IRCCS Ospedale Policlinico San Martino, Genova, Italy. 7. Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy. 8. Department of Statistics, Computer Science, Application "G. Parenti", University of Florence, Florence, Italy. 9. Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy. 10. Child Psychiatry and Neurology Unit, Policlinic Agostino Gemelli Foundation, IRCCS, Roma, Italy. 11. Child Psychiatry and Neurology Unit, G. Sales Hospital, Ancona, Italy. 12. Institute of Neuroscience, CNR, Parma, Italy. 13. Department of Human Neurosciences, Sapienza University, Rome, Italy. 14. Pediatric Neurosurgery, Policlinic Agostino Gemelli Foundation, IRCCS, Rome, Italy. 15. Neurosurgery Unit, Catholic University of Sacred Heart, Rome, Italy. 16. Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy. 17. Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy. 18. Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy.
Abstract
OBJECTIVE: To assess seizure and cognitive outcomes and their predictors in children (<16 years at surgery) and adults undergoing temporal lobe epilepsy (TLE) surgery in eight Italian centers. METHODS: This is a retrospective multicenter study. We performed a descriptive analysis and subsequently carried out multivariable mixed-effect models corrected for multiple comparisons. RESULTS: We analyzed data from 511 patients (114 children) and observed significant differences in several clinical features between adults and children. The possibility of achieving Engel class IA outcome and discontinuing antiepileptic drugs (AEDs) at last follow-up (FU) was significantly higher in children (P = .006 and < .0001). However, percentages of children and adults in Engel class I at last FU (mean ± SD, 45.9 ± 17 months in children; 45.9 ± 20.6 months in adults) did not differ significantly. We identified different predictors of seizure outcome in children vs adults and at short- vs long-term FU. The only variables consistently associated with class I outcome over time were postoperative electroencephalography (EEG) in adults (abnormal, improved,odds ratio [OR] = 0.414, P = .023, Q = 0.046 vs normal, at 2-year FU and abnormal, improved, OR = 0.301, P = .001, Q = 0.002 vs normal, at last FU) and the completeness of resection of temporal magnetic resonance (MR) abnormalities other than hippocampal sclerosis in children (OR = 7.93, P = .001, Q = 0.003, at 2-year FU and OR = 45.03, P < .0001, Q < 0.0001, at last FU). Cognitive outcome was best predicted by preoperative performances in either age group. SIGNIFICANCE: Clinical differences between adult and pediatric patients undergoing TLE surgery are reflected in differences in long-term outcomes and predictors of failures. Children are more likely to achieve sustained seizure freedom and withdraw AEDs after TLE surgery. Earlier referral should be encouraged as it can improve surgical outcome.
OBJECTIVE: To assess seizure and cognitive outcomes and their predictors in children (<16 years at surgery) and adults undergoing temporal lobe epilepsy (TLE) surgery in eight Italian centers. METHODS: This is a retrospective multicenter study. We performed a descriptive analysis and subsequently carried out multivariable mixed-effect models corrected for multiple comparisons. RESULTS: We analyzed data from 511 patients (114 children) and observed significant differences in several clinical features between adults and children. The possibility of achieving Engel class IA outcome and discontinuing antiepileptic drugs (AEDs) at last follow-up (FU) was significantly higher in children (P = .006 and < .0001). However, percentages of children and adults in Engel class I at last FU (mean ± SD, 45.9 ± 17 months in children; 45.9 ± 20.6 months in adults) did not differ significantly. We identified different predictors of seizure outcome in children vs adults and at short- vs long-term FU. The only variables consistently associated with class I outcome over time were postoperative electroencephalography (EEG) in adults (abnormal, improved,odds ratio [OR] = 0.414, P = .023, Q = 0.046 vs normal, at 2-year FU and abnormal, improved, OR = 0.301, P = .001, Q = 0.002 vs normal, at last FU) and the completeness of resection of temporal magnetic resonance (MR) abnormalities other than hippocampal sclerosis in children (OR = 7.93, P = .001, Q = 0.003, at 2-year FU and OR = 45.03, P < .0001, Q < 0.0001, at last FU). Cognitive outcome was best predicted by preoperative performances in either age group. SIGNIFICANCE: Clinical differences between adult and pediatric patients undergoing TLE surgery are reflected in differences in long-term outcomes and predictors of failures. Children are more likely to achieve sustained seizure freedom and withdraw AEDs after TLE surgery. Earlier referral should be encouraged as it can improve surgical outcome.
Authors: Veronica Pelliccia; Francesco Cardinale; Ginevra Giovannelli; Laura Castana; Marco de Curtis; Laura Tassi Journal: Epilepsy Behav Rep Date: 2022-08-29