Children with drug-resistant epilepsy live longer after cranial surgery, large study finds

Survival charge past 10 years in kids with drug-resistant epilepsy (DRE) was highest after cranial epilepsy surgical procedure and lowest when handled solely with antiseizure medicines, based on a examine printed in The Lancet Youngster and Adolescent Well being.

This huge, retrospective examine was the primary to check long-term survival in kids with DRE amongst cohorts handled with medicines solely, vagus nerve stimulation plus medicines, and cranial epilepsy surgical procedure plus medicines. Outcomes present that threat of early demise was decreased by over 80% after surgical procedure and by 40% after vagus nerve stimulation, in comparison with medication-only therapy.

Individuals with epilepsy have elevated mortality charges in comparison with the age-matched inhabitants. Epilepsy is likely one of the commonest neurological circumstances, affecting at the very least 3.4 million folks in the US. Amongst kids with epilepsy, an estimated 20% have DRE.

“We offer vital proof for healthcare choice making for pediatric sufferers with drug-resistant epilepsy,” mentioned senior writer Sandi Lam, MD, Division Head of Neurosurgery at Ann & Robert H. Lurie Youngsters’s Hospital of Chicago and Professor of Neurological Surgical procedure at Northwestern College Feinberg College of Drugs. “Our findings additionally spotlight the significance of the multidisciplinary staff method to the therapy of epilepsy, resembling that supplied at a complete epilepsy heart, which incorporates tailor-made analysis and deployment of medical and surgical therapy choices for sufferers with this difficult illness.”

Nevertheless, fewer than 1% of sufferers of all ages with DRE are referred to complete epilepsy facilities. An estimated 100,000 to 200,000 folks for whom epilepsy surgical procedure is indicated don’t obtain it, based on the Heart for Illness Management and Prevention (CDC) and Institute of Drugs.

“In mild of our examine’s findings, the catastrophic underutilization of epilepsy surgical procedure might immediately result in avoidable untimely deaths in pediatric epilepsy sufferers annually,” mentioned Dr. Lam. “Epilepsy surgical procedure is established as a protected and efficient therapy, even in infants youthful than three months of age. We have to enhance early referral for complete epilepsy analysis to restrict the dangerous results of ongoing seizures within the growing mind and to lower the time to surgical procedure. We present that kids’s lives might rely on it.”

Dr. Lam and colleagues additionally discovered disparities in entry to epilepsy surgical procedure. White, privately insured kids had been extra more likely to obtain surgical therapy.

“Our discovering of disparities in entry to epilepsy surgical procedure must be explored additional to establish multifactorial causes and intention to enhance healthcare supply and well being fairness within the therapy of pediatric epilepsy,” mentioned Dr. Lam.

The examine included a complete of 18,292 pediatric sufferers (0-17 years of age) with DRE. Knowledge had been obtained from the Youngsters’s Hospital Affiliation’s Pediatric Well being Info System (PHIS), an administrative database that incorporates inpatient, emergency division, ambulatory, and statement encounter degree knowledge from 44 kids’s hospitals in the US.

“Youngsters with drug-resistant epilepsy ought to bear analysis for all therapy choices, with elevated consideration of candidacy for cranial epilepsy surgical procedure or neurostimulation resembling vagus nerve stimulation,” burdened Dr. Lam, who additionally holds the Yeager Professorship in Pediatric Neurosurgery.