E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Etiology, Long-Term Outcomes, and Prognostic Factors in Children with Refractory Epilepsy Undergoing Epilepsy Surgery
Ayfer Sakarya Güneş✉ ,
Nubar Haciyeva ,
Hülya Maraş Genç ,
Emek Uyur ,
Adnan Deniz ,
Defne Alikılıç ,
Ömer Karaca ,
Merve Öztürk ,
Gökçe Cırdı ,
Anıl Gök ,
Orgun Tekin ,
Yonca Anık ,
Nerses Bebek ,
Serkan İşgören ,
Candan Gürses ,
Bülent Kara ,
Altay Sencer
DOI: 10.5137/1019-5149.JTN.49601-25.3
Article in Press
Corresponding Author:
Ayfer Sakarya Güneş (ayfer-sakarya@hotmail.com)
Abstract
Aim
To investigate the etiological spectrum, presurgical characteristics, and long-term surgical outcomes in children with drug-resistant epilepsy (DRE) and to identify clinical, electrophysiological, and imaging-based predictors of favorable outcomes.
Material and Methods
A retrospective analysis was conducted on a total of 41 pediatric patients who underwent epilepsy surgery between 2007 and 2024 at a tertiary medical center. Presurgical evaluations included MRI, EEG, PET/SPECT, and histopathology. Seizure outcomes were evaluated using the Engel and ILAE classifications, and prognostic factors were determined using subgroup and regression analyses.
Results
At the final follow-up (median, 72 months), 56.4% of the patients achieved Engel Class I seizure freedom, and anti-seizure medications were discontinued in 30.8% of the cases. Favorable outcomes were significantly associated with seizure onset after 24 months (80% vs. 31.6%), normal neurodevelopment (75% vs. 26.7%), and clear MRI lesions (73.3%). Interictal EEG lateralization demonstrated a descriptive trend towards improved outcomes; however, this finding was not statistically significant. PET positivity demonstrated an independent association with Engel Class I outcomes in the multivariate analysis (OR: 19.65, 95% CI: 1.55248.85). The patients who underwent temporal lobe resection achieved a higher rate of seizure freedom (75%) compared to those who underwent extratemporal surgery (50%). Pathogenic genetic variants were identified in patients with poor outcomes.
Conclusion
This study underscores the value of epilepsy surgery as a therapeutic option for selected pediatric DRE cases. A comprehensive presurgical evaluation, including advanced neuroimaging, detailed EEG analysis, and targeted genetic testing, is crucial for optimizing surgical outcomes. Integrating the Engel and ILAE classifications provides a more comprehensive assessment of long-term seizure outcomes.
To investigate the etiological spectrum, presurgical characteristics, and long-term surgical outcomes in children with drug-resistant epilepsy (DRE) and to identify clinical, electrophysiological, and imaging-based predictors of favorable outcomes.
Material and Methods
A retrospective analysis was conducted on a total of 41 pediatric patients who underwent epilepsy surgery between 2007 and 2024 at a tertiary medical center. Presurgical evaluations included MRI, EEG, PET/SPECT, and histopathology. Seizure outcomes were evaluated using the Engel and ILAE classifications, and prognostic factors were determined using subgroup and regression analyses.
Results
At the final follow-up (median, 72 months), 56.4% of the patients achieved Engel Class I seizure freedom, and anti-seizure medications were discontinued in 30.8% of the cases. Favorable outcomes were significantly associated with seizure onset after 24 months (80% vs. 31.6%), normal neurodevelopment (75% vs. 26.7%), and clear MRI lesions (73.3%). Interictal EEG lateralization demonstrated a descriptive trend towards improved outcomes; however, this finding was not statistically significant. PET positivity demonstrated an independent association with Engel Class I outcomes in the multivariate analysis (OR: 19.65, 95% CI: 1.55248.85). The patients who underwent temporal lobe resection achieved a higher rate of seizure freedom (75%) compared to those who underwent extratemporal surgery (50%). Pathogenic genetic variants were identified in patients with poor outcomes.
Conclusion
This study underscores the value of epilepsy surgery as a therapeutic option for selected pediatric DRE cases. A comprehensive presurgical evaluation, including advanced neuroimaging, detailed EEG analysis, and targeted genetic testing, is crucial for optimizing surgical outcomes. Integrating the Engel and ILAE classifications provides a more comprehensive assessment of long-term seizure outcomes.
Keywords
Drug-resistant epilepsy
pediatric epilepsy surgery
treatment outcome
prognostic predictors
genetic analysis/epilepsy