Journal Article

8350 Outcomes of the Scottish paediatric epilepsy surgery service

Churchward, Sarah, Fyall Janice, Jothy, Kandasamy, Lindsay Eilidh, Shetty, Jay, Sokol Drahuslav, McLellan Ailsa

2025

Overview

Why did you do this work?Epilepsy is one of the most prevalent neurological diseases in childhood, affecting 1 in 220 children under 18 years old.1 Treatment with anti-epileptic drugs will not achieve seizure freedom in around 25% of these children.2 Surgical treatment is an option in selected cases and is a standard of care in this cohort, depending on aetiology and seizure burden. In Scotland, these children are reviewed by the Scottish Paediatric Epilepsy Surgery Service (SPESS) multidisciplinary team (MDT). We examined rates of seizure freedom following surgery and compared the outcomes to international data and to children from one centre assessed by the MDT who were not deemed suitable for surgery.What did you do?Cases were identified from the SPESS database for children assessed from 2010 to 2022, with some additional information taken from electronic health records (TrakCare). Surgical data was from all centres in Scotland whereas medical data was from Lothian only. Follow-up assessment was conducted at 6 and 12 months. Baseline characteristics included age, sex and MRI findings. Engel’s classification was used to summarise surgery outcome, with Engel’s class I representing seizure freedom. In Lothian children who continued medical treatment, outcome was classified as continuing seizures with or without treatment or seizure-free. A multivariate logistic regression model was used to assess whether specific characteristics were predictive of seizure freedom.What did you find?Of the 280 children discussed at MDT meetings (mean age 9.8 ± 5 years; 55.4% male), 114 (40.7%) were selected for epilepsy surgery (53.5% male, with a mean duration of DRE of 2.6 years). The mean time from first seizure to surgery was 6.2 years. At 12 months post-surgery, 68.8% of the children were seizure-free (Engel class I), which is consistent with international data reporting seizure freedom rates between 62.5% and 96% at 12 months.3 4 Factors associated with a higher likelihood of seizure freedom included an older age at seizure onset, a shorter duration of DRE, and abnormal MRI findings.In the Lothian cohort who continued medical treatment, 42.9% achieved seizure freedom at 12 months. The difference in outcomes between the surgical and non-surgical groups was not statistically significant (p = 0.053).What does it mean?Our study found that children selected for epilepsy surgery had a high rate of seizure freedom at 12 months, similar to international reports. While children who continued medical treatment had worse outcomes, the difference was not statistically significant however this data is not fully comparable as it was from Lothian only. These findings highlight the importance of timely identification and referral of suitable candidates for epilepsy surgery to improve long-term outcomes.ReferencesEpilepsy prevalence, incidence and other statistics Joint Epilepsy Council of the UK and Ireland. 2011.Sultana B, Panzini MA, Veilleux Carpentier A, Comtois J, Rioux B, Gore G, et al. Incidence and Prevalence of Drug-Resistant Epilepsy: A Systematic Review and Meta-analysis. Neurology. 2021 Apr 27 [cited 2024 Mar 18];96(17):805–17. Available from: https://pubmed.ncbi.nlm.nih.gov/33722992/Mir A, Jallul T, Alotaibi F, Amer F, Najjar A, Alhazmi R, et al. Outcomes of resective surgery in pediatric patients with drug-resistant epilepsy: A single-center study from the Eastern Mediterranean Region. Epilepsia Open. 2023 Sep 1 [cited 2024 Mar 12];8(3):930–45. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/epi4.12761Teutonico F, Mai R, Veggiotti P, Francione S, Tassi L, Borrelli P, et al. Epilepsy surgery in children: Evaluation of seizure outcome and predictive elements. Epilepsia 2013 Oct [cited 2024 Mar 8];54(SUPPL.7):70–6. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/epi.12312

• Publisher: BMJ Publishing Group LTD
• Subject: Children / Convulsions & seizures / Drug resistance / Electronic medical records / Epilepsy / Freedom / Magnetic resonance imaging / Medical Services / Medical treatment / Meta Analysis / Neurological diseases / Neurology / Pediatrics / Seizures / Statistical analysis / Surgery