Cranial Epilepsy Surgery Offers Hope for Children With Drug-Resistant Epilepsy

Results show that the risk of early
death was reduced by over 80 percent after surgery and by 40 percent
after vagus nerve stimulation, compared to medication-only
treatment.

Surviving Against the Odds

People with epilepsy have increased
mortality rates compared to the age-matched population. Epilepsy is
one of the most common neurological conditions, affecting at least
3.4 million people in the United States. Among
children with epilepsy, an estimated 20 percent have DRE.

“We provide critical evidence for
healthcare decision-making for pediatric patients with drug-resistant
epilepsy,” said senior author Sandi Lam, MD, 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 findings also
highlight the importance of the multidisciplinary team approach to
the treatment of epilepsy, such as that offered at a comprehensive
epilepsy center, which includes tailored evaluation and deployment of
medical and surgical treatment options for patients with this
challenging disease.”

However, fewer than 1 percent of
patients of all ages with DRE are referred to comprehensive epilepsy
centers. An estimated 100,000-200,000 people for whom epilepsy
surgery is indicated do not receive it, according to the Center for
Disease Control and Prevention (CDC) and Institute of Medicine.

From Medications to Surgery

“In light of our study’s findings,
the catastrophic underutilization of epilepsy surgery may directly
lead to avoidable premature deaths in pediatric epilepsy patients
each year,” said Dr. Lam. “Epilepsy surgery is established as a
safe and effective treatment, even in infants younger than 3 months
of age. We need to improve early referral for comprehensive epilepsy
evaluation to limit the harmful effects of ongoing seizures in the
developing brain and to decrease the time to surgery. We show that
children’s lives may depend on it.”

Dr. Lam and colleagues also found
disparities in access to epilepsy surgery. White, privately insured
children were more likely to receive surgical treatment.

“Our finding of disparities in
access to epilepsy surgery needs to be explored further to identify
multifactorial reasons and aim to improve healthcare delivery and
health equity in the treatment of pediatric epilepsy,” said Dr.
Lam.

Cranial Surgery Emerges as
a Game-Changer in Epilepsy Care

The study included a total of 18,292
pediatric patients (0-17 years of age) with DRE. Data were obtained
from the Children’s Hospital Association’s Pediatric
Health Information System (PHIS), an administrative
database that contains inpatient, emergency department, ambulatory,
and observation encounter level data from 44 children’s hospitals
in the United States.

“Children with drug-resistant
epilepsy should undergo evaluation for all treatment options, with
increased consideration of candidacy for cranial epilepsy surgery or
neurostimulation such as vagus nerve stimulation,” stressed Dr.
Lam, who also holds the Yeager Professorship in Pediatric
Neurosurgery.

Source: Eurekalert