Time to Palliative Epilepsy Surgery and Effect on Outcomes

Document Type

Conference Proceeding

Publication Date

12-7-2025

Abstract

Rationale: Epilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery. Studies have linked shorter epilepsy duration to good outcomes in definitive surgery. For children who are not candidates for definitive surgery palliative procedures can still result in significant seizure reduction. There is scant evidence on the impact of time to surgery on seizure reduction for palliative procedures. We reviewed data from the Pediatric Epilepsy Surgery Database to look for an association between epilepsy duration and reduction in seizure burden after palliative procedures. Methods: Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent and had at least 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherectomy, lesionectomy, and lobectomy. Outcomes were seizure freedom, 90% seizure reduction, and 50% seizure reduction at 6-12 months, and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction was adjusted for potential confounders. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure type. Results: 588 patients were included in the cohort. Initial univariate analysis suggested that shorter epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 month and >12 months (p< 0.01). After adjusting for confounders, only seizure freedom at > 12 months was significantly associated with duration of epilepsy (p< 0.01). There was an 8% (p = 0.01) reduction in seizure freedom for every year elapsed between seizure onset and the first surgery. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% (OR 0.75, p=0.03) and >90% (OR 0.77, p=0.02) seizure reduction at >12 months. Conclusions: Our data suggest that patients undergoing palliative epilepsy surgery are a heterogenous group, with outcomes mediated by non-modifiable risk factors including lesional epilepsy and candidacy for resective surgery. Initially, time to surgery was significant but after regression analysis only seizure freedom at >12 months maintained its significance. However, we provide evidence that even in palliative procedures, chances of seizure freedom may be optimized by early intervention. The benefits of early surgery are particularly apparent in lobectomy and when a lesion is present. A limitation of this study is that palliative resections were based on institutional definitions. Nevertheless, our data supports that a patient with drug-resistant epilepsy should be referred to an epilepsy surgery center even if they are not candidates for definitive surgery, and delay may lead to decreased likelihood of seizure freedom.

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American Epilepsy Society Annual Meeting, December 5-9, 2025, Atlanta, GA

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