Patients treated surgically reported better outcomes, including reduced AED use, higher rates of survival, and fewer epilepsy-related ED visits, hospitalizations, and outpatient visits.
Sandi Lam, MD, MBA
New study results suggest that patients with epilepsy who have refractory disease experienced significant reductions in their need for related healthcare services—inpatient, emergency department (ED), and epilepsy-related visits—after undergoing surgical treatment compared to those treated only with medication.1
All told, the assessment included 2106 patients treated with surgery and 10,186 treated with medication. The findings show that after 2 years, inpatient and ED visits were reduced by 36% and 47%, respectively, for the surgical group compared to the medication-only group. Additionally, at 5 years postindex date, the surgical group reported a 37% reduction in inpatient visits and 50% reduction in ED visits compared to the medication group.
“There is a heightened urgency to achieve seizure freedom in children to prevent developmental arrest or regression, particularly in children under 2 years of age,” said senior author Sandi Lam, MD, MBA, division head of neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, and professor of neurological surgery, Northwestern University Feinberg School of Medicine, in a statement.2 “Our study demonstrates critical benefits after epilepsy surgery, which underscores that all children with refractory epilepsy should be referred for surgical evaluation without delay.”
The total amount of epilepsy-associated visits was reduced by 39% and 43% in the surgical group at 2 and 5 years postindex, respectively, compared to the medication group. Within 2 years of the postindex date, the number of inpatient visits was 1.9 and 1.2, and number of ED visits were 1.4 and 0.7 for the medical and surgical patients, respectively. Epilepsy-associated visits were 1.9 and 1.1.
At the 5 year-mark, the number of inpatient visits was 3.9 and 2.5 and ED visits was 3.2 and 1.7 for medically and surgically treated patients, respectively. The number of epilepsy-associated visits was 6.4 and 3.9, respectively.
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Survival at 5 years was also significantly higher in the surgical group, with 98.99% of the group surviving, compared to 96.66% in the medication group.The overall survival rates were 99.58% and 98.07% at 2 years, respectively. A total of 47 (2.3%) and 9 (0.44%) cases in medically and surgically treated groups died within the follow-up period, respectively.
“Epilepsy not only impacts quality of life and clinical health. There are quantifiable consequences on mortality,” Lam said. “We know from previous studies that the risk of sudden unexplained death in epilepsy continues at up to 1 percent per year in children who do not have adequate seizure control. Higher survival is another compelling reason to not delay surgery.”
The average reduction in antiepileptic drugs (AEDs) utilized was 16% at 2 years and 5 years after treatment for the surgical group in comparison with the medical group. The number of AEDs used at baseline were similar between the 2 groups, with the medical group using a mean of 3.24 and the surgical group using a mean of 3.22. In the first year, the surgically treated group significantly dropped compared to medically treated patients, decreasing to 2.59, while the medical group decreased to 3.06.
After 2 years, 608 of 1188 (51.4%) medical and 426 of 1168 (36.7%) surgical patients had recorded AED use, with an average number of AEDs of 2.82 and 2.37, respectively. At 5 years, those numbers dropped to 149 of 461 (31.9%) in the medical and 121 of 520 (23.3%) in the surgical group had recorded AED use, with the average number of AEDs being 2.92 and 2.46, respectively.
“We demonstrate a decrease in ED visits, inpatient admissions, epilepsy-associated visits, and AED use over short-term and long-term follow up in the surgical group compared to the medical group,” Lam and colleagues concluded. “This suggests a long-term decrease in healthcare utilization in the group that received epilepsy surgery. Favorable clinical outcomes and substantial implications for both short- and long-term effectiveness emphasizes the importance of the role of epilepsy surgery in the treatment of refractory epilepsy in children.”