Conference Coverage
COLUMBUS, OHIO—Epilepsy surgery provides a substantially longer life expectancy than medical treatment for children with refractory epilepsy who are suitable surgical candidates, according to research presented at the 43rd Annual Meeting of the Child Neurology Society. The surgery benefits children with temporal lobe epilepsy and those with extratemporal epilepsy to a similar extent.
Iván Sánchez Fernández, MD, a research fellow in the Department of Neurology at Boston Children’s Hospital, and colleagues conducted a study to quantify the life expectancy of children with refractory epilepsy who were eligible for surgery. The investigators used a decision analysis model with input data from the literature to compare the life expectancy associated with medical treatment alone with that associated with epilepsy surgery. The model accounted for different probabilities associated with temporal and extratemporal epilepsy.
One-way and two-way sensitivity analyses were used to evaluate the robustness of the results across wide variations of input parameters. Second-order Monte Carlo simulations were used to evaluate the ways in which input parameter uncertainty in the literature influenced the selection of the preferred treatment strategy. The study’s main outcome was life expectancy.
In this decision analysis model, for patients between ages 3 and 21, epilepsy surgery offered a longer life expectancy than medical treatment alone, regardless of whether the epilepsy was temporal or extratemporal. The gain in life expectancy from epilepsy surgery, compared with that from medical treatment alone, was on the order of five to six years of life for temporal lobe epilepsy and extratemporal epilepsy across a wide range of pediatric ages and across a wide range of input parameter variations.
One-way and two-way sensitivity analyses indicated the robustness of the results for a wide range of values in individual input parameters, said the authors. Second-order Monte Carlo simulations demonstrated the robustness of epilepsy surgery as the preferred strategy, considering input parameter uncertainty in the current literature.
“There was no adjustment for quality of life, but we estimated the percentage of life expectancy spent in seizure freedom for each strategy, and epilepsy surgery was associated with a higher percentage of life expectancy spent in seizure freedom,” said Dr. Sánchez Fernández. For patients age 10 with refractory temporal epilepsy, 48.9% of their life expectancy would be seizure-free in the epilepsy surgery strategy, compared with 14.3% in the medical treatment alone strategy. For patients age 10 with refractory extratemporal epilepsy, 43.0% of their life expectancy would be seizure-free in the epilepsy surgery strategy, compared with 14.3% in the medical treatment only strategy. Complications from surgery were infrequent.
—Erik Greb