TY - JOUR
T1 - Clinical factors predict surgical outcomes in pediatric MRI-negative drug-resistant epilepsy
AU - Arya, Ravindra
AU - Leach, James L.
AU - Horn, Paul S.
AU - Greiner, Hansel M.
AU - Gelfand, Michael
AU - Byars, Anna W.
AU - Arthur, Todd M.
AU - Tenney, Jeffrey R.
AU - Jain, Sejal V.
AU - Rozhkov, Leonid
AU - Fujiwara, Hisako
AU - Rose, Douglas F.
AU - Mangano, Francesco T.
AU - Holland, Katherine D.
N1 - Funding Information:
RA receives research support from American Epilepsy Society/Epilepsy Foundation (pSERG consortium); KDH receives funding from the following NIH grants: R01 NS062756 (PI) , R01 NS062806 (Co-I) , and R01 NS065020 (Co-I) , other authors have no pertinent disclosures.
Publisher Copyright:
© 2016 British Epilepsy Association
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Purpose Lack of a potentially epileptogenic lesion on brain magnetic resonance imaging (MRI) is a poor prognostic marker for epilepsy surgery. We present a single-center series of childhood-onset MRI-negative drug-resistant epilepsy (DRE) and analyze surgical outcomes and predictors. Methods Children with MRI-negative DRE who had resective surgery from January 2007 to December 2013 were identified using an institutional database. Relevant clinical, neurophysiological, imaging, and surgical data was extracted. The primary outcome measure was seizure freedom. Predictors of seizure freedom were obtained using multivariate logistic regression. Results Out of 47 children with MRI-negative DRE, 12 (25.5%) were seizure free (International League Against Epilepsy [ILAE] outcome class I), after mean follow-up of 2.75 (±1.72) years. Seizure-free proportion was significantly higher in patients with single seizure semiology and concordant ictal EEG (50.0% vs. 15.2%, p = 0.025). Multivariate analysis using only non-invasive pre-surgical data showed that children with daily seizures (OR 0.02, 95% CI < 0.001–0.55), and earlier onset of seizures (OR 0.72, 95% CI 0.52–0.99) were less likely to be seizure-free. Also, each additional anti-epileptic drug (AED) tried before surgery decreased the probability of seizure-free outcome (OR 0.16, 95% CI 0.04–0.63). Repeat multivariate analysis after including surgical variables found no additional significant predictors of seizure-freedom. Cortical dysplasia (ILAE type IB) was the commonest histopathology. Conclusion Surgical outcomes in children with MRI-negative DRE are determined by clinical factors including seizure frequency, age of onset of seizures, and number of failed AEDs.
AB - Purpose Lack of a potentially epileptogenic lesion on brain magnetic resonance imaging (MRI) is a poor prognostic marker for epilepsy surgery. We present a single-center series of childhood-onset MRI-negative drug-resistant epilepsy (DRE) and analyze surgical outcomes and predictors. Methods Children with MRI-negative DRE who had resective surgery from January 2007 to December 2013 were identified using an institutional database. Relevant clinical, neurophysiological, imaging, and surgical data was extracted. The primary outcome measure was seizure freedom. Predictors of seizure freedom were obtained using multivariate logistic regression. Results Out of 47 children with MRI-negative DRE, 12 (25.5%) were seizure free (International League Against Epilepsy [ILAE] outcome class I), after mean follow-up of 2.75 (±1.72) years. Seizure-free proportion was significantly higher in patients with single seizure semiology and concordant ictal EEG (50.0% vs. 15.2%, p = 0.025). Multivariate analysis using only non-invasive pre-surgical data showed that children with daily seizures (OR 0.02, 95% CI < 0.001–0.55), and earlier onset of seizures (OR 0.72, 95% CI 0.52–0.99) were less likely to be seizure-free. Also, each additional anti-epileptic drug (AED) tried before surgery decreased the probability of seizure-free outcome (OR 0.16, 95% CI 0.04–0.63). Repeat multivariate analysis after including surgical variables found no additional significant predictors of seizure-freedom. Cortical dysplasia (ILAE type IB) was the commonest histopathology. Conclusion Surgical outcomes in children with MRI-negative DRE are determined by clinical factors including seizure frequency, age of onset of seizures, and number of failed AEDs.
KW - Childhood epilepsy
KW - Drug-resistant epilepsy
KW - Epilepsy surgery
KW - MRI negative epilepsy
KW - Outcomes
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U2 - 10.1016/j.seizure.2016.07.004
DO - 10.1016/j.seizure.2016.07.004
M3 - Article
C2 - 27474907
AN - SCOPUS:84979609074
SN - 1059-1311
VL - 41
SP - 56
EP - 61
JO - Seizure : the journal of the British Epilepsy Association
JF - Seizure : the journal of the British Epilepsy Association
ER -