Epilepsy surgery in children with refractory epilepsy, who have poor seizure control with medications, results in better outcomes, according to a study published in the journal Neurosurgery. Better outcomes with surgery include reduced antiepileptic medication use, higher rates of survival, and fewer epilepsy-related emergency department visits, fewer hospitalizations and fewer outpatient visits. The study compared the effectiveness of epilepsy surgery versus medication treatment in this population, and, for the first time, examined the impact on healthcare utilization after two years and five years.
“There is a heightened urgency to achieve seizure freedom in children to prevent developmental arrest or regression, particularly in children under 2 years of age,” says senior author Sandi Lam, MD, MBA, Division Head of Neurosurgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Neurological Surgery at Northwestern University Feinberg School of Medicine. “Our study demonstrates critical benefits after epilepsy surgery, which underscores that all children with refractory epilepsy should be referred for surgical evaluation without delay.”
An estimated 470,000 children in the United States have epilepsy, and among them, up to 30 percent have seizures that are refractory to medical management. While children with poor seizure control are at increased risk for developmental delay and learning disabilities, less than 1 percent of patients with refractory epilepsy are referred to epilepsy centers for surgical evaluation.
To conduct the study, Dr. Lam and colleagues analyzed the Children’s Hospital Association’s Pediatric Health Information System (PHIS) data, which contains de-identified administrative information on inpatient, emergency department and observation-level encounters from over 40 children’s hospitals. Patient demographics and treatment details are also included. The study compared outcomes of over 4,000 patients and over 2000 matched cases of refractory epilepsy, with half of the patients in the surgical group and the other half in the medication only group.
One of the outcomes examined was survival. Dr. Lam and colleagues found significantly higher survival in the surgical group at five-year follow-up.
“Epilepsy not only impacts quality of life and clinical health. There are quantifiable consequences on mortality,” says Dr. Lam. “We know from previous studies that the risk of sudden unexplained death in epilepsy continues at up to 1 percent per year in children who do not have adequate seizure control. Higher survival is another compelling reason to not delay surgery.”
The study also found that compared to medically treated patients with refractory epilepsy, healthcare utilization was reduced in the surgically-treated group at two-years and five-years after surgery. Inpatient visits were reduced by 36 and 37 percent (at two- and five-years respectively), emergency department visits by 47 and 50 percent, and the total number of epilepsy-associated visits were reduced by 39 and 43 percent in the surgical group. The average reduction on antiepileptic medications was 16 percent at follow-up.
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 220,000 children from 48 states and 49 countries.