Abstract：
BACKGROUND: Epilepsy surgery is an underutilized resource for children with drug-resistant epilepsy. Palliative and definitive surgical options can reduce seizure burden and improve quality of life. Palliative epilepsy surgery is often seen as a \"last resort\" compared to definitive surgical options. We compare patient characteristics between palliative and definitive epilepsy surgical patients and present palliative surgical outcomes from the Pediatric Epilepsy Research Consortium surgical database.
METHODS: The Pediatric Epilepsy Research Consortium Epilepsy Surgery database is a prospective registry of patients aged 0-18 years undergoing evaluation for epilepsy surgery at 20 pediatric epilepsy centers. We included all children with completed surgical therapy characterized as definitive or palliative. Demographics, epilepsy type, age of onset, age at referral, etiology of epilepsy, treatment history, time-to-referral/evaluation, number of failed anti-seizure medications (ASMs), imaging results, type of surgery, and postoperative outcome were acquired.
RESULTS: Six hundred forty patients undergoing epilepsy surgery were identified. Patients undergoing palliative procedures were younger at seizure onset (median: 2.1 vs 4 years, P= 0.0008), failed more ASM trials before referral for presurgical evaluation (P=<0.0001), and had longer duration of epilepsy before referral for surgery (P=<0.0001). During presurgical evaluation, patients undergoing palliative surgery had shorter median duration of video-EEG data collected (P=0.007) but number of cases where ictal data were acquired was similar between groups. The most commonly performed palliative procedure was corpus callosotmy (31%), followed by lobectomy (21%) and neuromodulation (82% responsive neurostimulation vs 18% deep brain stimulation). Palliative patients were further categorized into traditionally palliative procedures vs traditionally definitive procedures. The majority of palliative patients had 50% reduction or better in seizure burden. Seizure free outcomes were significantly higher among those with traditional definitive surgeries, 41% (95% confidence interval: 26% to 57%) compared with traditional palliative surgeries and 9% (95% confidence interval: 2% to 17%). Rate of seizure freedom was 46% at 24 months or greater of follow-up in the traditional definitive group.
CONCLUSIONS: Patients receiving palliative epilepsy surgery trialed more ASMs, were referred later after becoming drug resistant, and had longer gaps between drug resistance and epilepsy surgery compared with patients undergoing definitive epilepsy surgery. The extent of surgical evaluation is impacted if surgery is thought to be palliative. A majority of palliative surgery patients achieved >50% seizure reduction at follow-up, both in groups that received traditionally palliative and traditionally definitive surgical procedures. Palliative surgical patients can achieve greater seizure control and should be referred to an epilepsy surgery center promptly after failing two appropriate anti-seizure medications.
METHODS: The Pediatric Epilepsy Research Consortium Epilepsy Surgery database is a prospective registry of patients aged 0-18 years undergoing evaluation for epilepsy surgery at 20 pediatric epilepsy centers. We included all children with completed surgical therapy characterized as definitive or palliative. Demographics, epilepsy type, age of onset, age at referral, etiology of epilepsy, treatment history, time-to-referral/evaluation, number of failed anti-seizure medications (ASMs), imaging results, type of surgery, and postoperative outcome were acquired.
RESULTS: Six hundred forty patients undergoing epilepsy surgery were identified. Patients undergoing palliative procedures were younger at seizure onset (median: 2.1 vs 4 years, P= 0.0008), failed more ASM trials before referral for presurgical evaluation (P=<0.0001), and had longer duration of epilepsy before referral for surgery (P=<0.0001). During presurgical evaluation, patients undergoing palliative surgery had shorter median duration of video-EEG data collected (P=0.007) but number of cases where ictal data were acquired was similar between groups. The most commonly performed palliative procedure was corpus callosotmy (31%), followed by lobectomy (21%) and neuromodulation (82% responsive neurostimulation vs 18% deep brain stimulation). Palliative patients were further categorized into traditionally palliative procedures vs traditionally definitive procedures. The majority of palliative patients had 50% reduction or better in seizure burden. Seizure free outcomes were significantly higher among those with traditional definitive surgeries, 41% (95% confidence interval: 26% to 57%) compared with traditional palliative surgeries and 9% (95% confidence interval: 2% to 17%). Rate of seizure freedom was 46% at 24 months or greater of follow-up in the traditional definitive group.
CONCLUSIONS: Patients receiving palliative epilepsy surgery trialed more ASMs, were referred later after becoming drug resistant, and had longer gaps between drug resistance and epilepsy surgery compared with patients undergoing definitive epilepsy surgery. The extent of surgical evaluation is impacted if surgery is thought to be palliative. A majority of palliative surgery patients achieved >50% seizure reduction at follow-up, both in groups that received traditionally palliative and traditionally definitive surgical procedures. Palliative surgical patients can achieve greater seizure control and should be referred to an epilepsy surgery center promptly after failing two appropriate anti-seizure medications.
摘要：
背景：癫痫手术是耐药癫痫患儿未充分利用的资源。姑息性和确定性手术选择可以减轻癫痫发作负担并改善生活质量。与明确的手术选择相比，姑息性癫痫手术通常被视为“最后手段”。我们比较了姑息性和确定性癫痫手术患者的患者特征，并从小儿癫痫研究联盟手术数据库中介绍了姑息性手术结果。
方法：小儿癫痫研究协会癫痫外科数据库是一项前瞻性登记，记录了在20个小儿癫痫中心接受癫痫手术评估的0-18岁患者。我们纳入了所有完成手术治疗的儿童，其特征是确定性或姑息性。人口统计,癫痫类型,发病年龄,转诊时的年龄，癫痫的病因，治疗史,转诊/评估的时间，失败的抗癫痫药物（ASM）的数量，成像结果,手术类型,并获得术后结果。
结果：确认了640名接受癫痫手术的患者。接受姑息治疗的患者在癫痫发作时年龄较小（中位数：2.1vs4年，P=0.0008),在转诊进行术前评估之前，更多的ASM试验失败(P=<0.0001)，并且在转诊手术前癫痫持续时间较长（P=<0.0001）。术前评估期间,接受姑息性手术的患者收集的视频-脑电图数据的中位持续时间较短(P=0.007),但获得发作数据的病例数在组间相似.最常见的姑息性手术是calllosotmy体（31％），其次是肺叶切除术（21％）和神经调节（82％的反应性神经刺激vs18％的深部脑刺激）。姑息性患者进一步分为传统姑息性手术和传统确定手术。大多数姑息患者的癫痫发作负担减少了50％或更好。传统确定性手术的无癫痫结局明显更高，41％（95％置信区间：26％至57％）与传统姑息性手术和9％（95％置信区间：2％至17％）相比。传统确定组随访24个月或更长时间的癫痫发作自由率为46%。
结论：接受姑息性癫痫手术的患者进行了更多的ASM试验，后来在变得耐药后被转诊，与接受确定性癫痫手术的患者相比，耐药性和癫痫手术之间的差距更长。如果手术被认为是姑息性的，则手术评估的程度会受到影响。大多数姑息性手术患者在随访时癫痫发作减少>50%，两组均接受传统姑息性手术和传统确定性手术。姑息性手术患者可以更好地控制癫痫发作，在两种适当的抗癫痫药物失败后，应立即转诊至癫痫手术中心。
方法：小儿癫痫研究协会癫痫外科数据库是一项前瞻性登记，记录了在20个小儿癫痫中心接受癫痫手术评估的0-18岁患者。我们纳入了所有完成手术治疗的儿童，其特征是确定性或姑息性。人口统计,癫痫类型,发病年龄,转诊时的年龄，癫痫的病因，治疗史,转诊/评估的时间，失败的抗癫痫药物（ASM）的数量，成像结果,手术类型,并获得术后结果。
结果：确认了640名接受癫痫手术的患者。接受姑息治疗的患者在癫痫发作时年龄较小（中位数：2.1vs4年，P=0.0008),在转诊进行术前评估之前，更多的ASM试验失败(P=<0.0001)，并且在转诊手术前癫痫持续时间较长（P=<0.0001）。术前评估期间,接受姑息性手术的患者收集的视频-脑电图数据的中位持续时间较短(P=0.007),但获得发作数据的病例数在组间相似.最常见的姑息性手术是calllosotmy体（31％），其次是肺叶切除术（21％）和神经调节（82％的反应性神经刺激vs18％的深部脑刺激）。姑息性患者进一步分为传统姑息性手术和传统确定手术。大多数姑息患者的癫痫发作负担减少了50％或更好。传统确定性手术的无癫痫结局明显更高，41％（95％置信区间：26％至57％）与传统姑息性手术和9％（95％置信区间：2％至17％）相比。传统确定组随访24个月或更长时间的癫痫发作自由率为46%。
结论：接受姑息性癫痫手术的患者进行了更多的ASM试验，后来在变得耐药后被转诊，与接受确定性癫痫手术的患者相比，耐药性和癫痫手术之间的差距更长。如果手术被认为是姑息性的，则手术评估的程度会受到影响。大多数姑息性手术患者在随访时癫痫发作减少>50%，两组均接受传统姑息性手术和传统确定性手术。姑息性手术患者可以更好地控制癫痫发作，在两种适当的抗癫痫药物失败后，应立即转诊至癫痫手术中心。
