Surgery After Failing More Medications Linked to Lower Seizure Freedom

Source: Neurology

Summary

This study looked at children with drug-resistant epilepsy, which means their seizures do not respond well to medication. Researchers analyzed data from 1,767 patients under 18 years old who began the process for epilepsy surgery at 24 pediatric epilepsy centers in the United States between January 2018 and February 2023. They wanted to find out how many medication trials these children went through before being evaluated for surgery and how this affected their chances of becoming seizure-free after the operation.

The findings showed that nearly 55% of the children started the surgical evaluation after failing more than two medications. Factors that led to later evaluations included having genetic causes for their epilepsy, experiencing generalized seizures, having daily seizures, and showing multiple seizure types. Children who were evaluated after failing two or fewer medications had a better chance of being seizure-free after surgery—about 61% compared to 39% for those evaluated later. However, even among those who had more medication trials, 80% still saw a significant reduction in their seizures.

This research highlights the importance of timely surgical evaluation for children with drug-resistant epilepsy. It suggests that waiting too long, after trying more than two medications, may be linked to more complex epilepsy and lower chances of complete seizure freedom. However, even if full seizure control isn't achieved, many children still benefit from surgery, experiencing a significant decrease in seizures. The study has limitations, such as being retrospective and not covering all possible factors, but it provides valuable insights into the treatment of pediatric epilepsy.

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