Effect of time to palliative epilepsy surgery on outcomes

OBJECTIVE: Epilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery; however, an analogous effect in palliative procedures has not been shown. We reviewed the Pediatric Epilepsy Surgery Database data for an association between epilepsy duration and seizure reduction in palliative procedures. METHODS: Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered at 6-12 months and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure. RESULTS: A total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures. SIGNIFICANCE: We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.

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Publication Details

Journal
Epilepsia
Published
2026-08-03
DOI
https://doi.org/10.1002/epi.70379
Primary Topic
Epilepsy research and treatment
Type
article
Field-Weighted Citation Impact
0.00
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article

Effect of time to palliative epilepsy surgery on outcomes

Rani K. Singh, Kristen H. Arredondo, D. Miller, Janelle L. Wagner et al.
Epilepsia
Epilepsy research and treatment
article

Effect of time to palliative epilepsy surgery on outcomes

Rani K. Singh, Kristen H. Arredondo, D. Miller, Janelle L. Wagner, Cemal Karakas, Pradeep Javarayee, Jason S. Hauptman, Michael Scott Perry, Fernando Galán, Kurtis I. Auguste, Dallas Armstrong, William D. Gaillard, David Horvat, Patricia E. McGoldrick, Steven M. Wolf, Pilar Pichon, Aran Groves, Andrew Knox, Edward J. Novotny, Michael A. Ciliberto, Debopam Samanta, Krista Eschbach, Shilpa B. Reddy, Adam P. Ostendorf, Allyson Alexander, Taylor J. Abel, Lily C. Wong‐Kisiel, Nitin Agarwal, Danilo Bernardo, Jenny Lin, Jeffrey Bolton, Dewi F. Depositario‐Cabacar, Robert M. Crutcher, Avery R. Caraway, David Bonda
article en

Abstract

OBJECTIVE: Epilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery; however, an analogous effect in palliative procedures has not been shown. We reviewed the Pediatric Epilepsy Surgery Database data for an association between epilepsy duration and seizure reduction in palliative procedures. METHODS: Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered at 6-12 months and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure. RESULTS: A total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures. SIGNIFICANCE: We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.

Epilepsia
University of Iowa (US), Cedars-Sinai Medical Center (US), George Washington University Hospital (US), Mount Sinai Beth Israel (US), Boston Children's Hospital (US), Children's Hospital of Orange County (US), Nationwide Children's Hospital (US), Alexander T. Augusta Military Medical Center (US), St. Luke's-Roosevelt Hospital Center (US), Mayo Clinic (US), Children's National (US), University of Wisconsin–Madison (US), Harvard University (US), Medical University of South Carolina (US), University of Pittsburgh (US), University of California, San Francisco (US), Medical College of Wisconsin (US), University of Arkansas Medical Center (US), Brentwood Hospital (US), Cook Children's Medical Center (US), Children's Hospital Colorado (US), Monroe Carell Jr. Children's Hospital (US), Seattle Children's Hospital (US), Minnesota Epilepsy Group (US), Phoenix Children's Hospital (US), Levine Children's Hospital (US), UCSF Benioff Children's Hospital (US), Children's Healthcare of Atlanta (US), Doernbecher Children's Hospital (US), University of Arkansas for Medical Sciences (US), The University of Texas at Austin (US), The University of Texas Southwestern Medical Center (US), University of Colorado Denver (US)
Peace, Justice and strong institutions
Openalex Percentile: Top 9%
Epilepsy research and treatment
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