Effect of time to palliative epilepsy surgery on outcomes.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Crutcher Robert M, Horvat David E, Caraway Avery R, Arredondo Kristen H, Abel Taylor J, Agarwal Nitin, Alexander Allyson L, Armstrong Dallas Michael, Auguste Kurtis I, Bernardo Danilo, Bolton Jeffrey, Bonda David, Depositario-Cabacar Dewi Frances, Eschbach Krista, Gaillard William D, Groves Aran, Hauptman Jason S, Javarayee Pradeep K, Karakas Cemal, Knox Andrew T, Lin Jenny J, McGoldrick Patricia E, Miller Derryl J, Novotny Edward John, Ostendorf Adam P, Pichon Pilar D, Reddy Shilpa B, Samanta Debopam, Singh Rani K, Wagner Janelle L, Wolf Steven M, Wong-Kisiel Lily C, Galan Fernando N, Perry M Scott, Ciliberto Michael A
Аннотация
METHODS: Patients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered 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 adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure.
RESULTS: A total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures.
SIGNIFICANCE: We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.