Delaying Epilepsy Surgery Evaluation May Hurt Children’s Outcomes

What was studied

Researchers looked at how long it took children with drug-resistant epilepsy to get a presurgical epilepsy evaluation after they were recognized as having drug-resistant epilepsy. They used a prospective database from 29 centers in the United States, making this a large multicenter study.

The study included 1,310 children. The key timing measure was the gap between drug-resistant epilepsy diagnosis and a phase 1 video-EEG admission. The researchers grouped children into those evaluated within 1 year and those evaluated after 1 year or more. They also looked at 624 children who went on to have epilepsy surgery and compared seizure freedom between the groups.

What they found

About 55% of children had a presurgical evaluation within 1 year, while 45% had a longer delay. Shorter time to evaluation was associated with lesional epilepsy, focal seizures, and a normal neurologic exam. Structural congenital and acquired etiologies were also linked to shorter time to evaluation, while genetic etiologies were linked to longer time to evaluation. The abstract also states that delays were particularly seen in patients with MRI-negative, generalized, or genetic epilepsies.

Among children who had surgery, 53% of those evaluated within 1 year were seizure-free, compared with 27% of those evaluated after 1 year or more. After accounting for other factors, a longer delay remained associated with a lower chance of seizure freedom. The study also found that the interval after drug-resistant epilepsy diagnosis, rather than total epilepsy duration, predicted outcomes.

Limits of the evidence

This was an observational study, so it cannot show from the abstract alone that delay itself caused worse outcomes. Children with earlier and later evaluation may have differed in important ways, even though the researchers adjusted for several factors.

The study focused on children treated at US epilepsy centers, so results may not apply the same way in all settings. The abstract does not provide details such as how drug-resistant epilepsy was diagnosed at each center, how long children were followed after surgery, or whether outcomes besides seizure freedom differed.

For families and caregivers

This study suggests that once a child is known to have drug-resistant epilepsy, earlier referral for presurgical evaluation may be important. The abstract indicates that delays were particularly common in children with MRI-negative, generalized, or genetic epilepsies.

For families, this does not mean every child should have surgery. It does suggest that timely evaluation at an epilepsy center may help clarify options and was associated in this study with better seizure freedom among children who went on to have surgery.

What to watch next

More research could help confirm these findings, including studies that follow children from the time drug-resistant epilepsy is diagnosed and report longer-term outcomes across different epilepsy types.

Terms in this summary

drug-resistant epilepsy

Epilepsy in which seizures continue despite trying appropriate seizure medicines.

presurgical evaluation

Testing done to see whether epilepsy surgery might help and how it could be done safely.

video-EEG

A hospital test that records brain waves and video at the same time to study seizures.

focal seizures

Seizures that start in one area of the brain.

generalized epilepsy

Epilepsy in which seizures involve both sides of the brain from the start.

MRI-negative

When a brain MRI does not show a clear abnormality that explains the seizures.

etiology

The underlying cause of a disease or condition.

seizure freedom

Having no seizures after treatment for a period of time.