Отсрочка предоперационной оценки снижает шансы на избавление от приступов у детей с лекарственно-устойчивой эпилепсией

Children with drug-resistant epilepsy (DRE) who undergo presurgical evaluation at least 1 year after DRE diagnosis have lower odds of achieving seizure freedom following epilepsy surgery than those evaluated earlier, according to findings published in Neurology: Clinical Practice. Although epilepsy surgery is an established treatment option for selected children with DRE, access to epilepsy surgery remains limited and evaluation is frequently delayed. Researchers examined factors associated with the timing of presurgical evaluation after DRE diagnosis. They also evaluated whether the timing of evaluation was associated with surgical outcomes. The researchers performed a multicenter observational analysis using prospectively collected data from the Pediatric Epilepsy Research Consortium Surgery Database. The study included children aged 18 years and younger who underwent an initial epilepsy surgery evaluation at 29 US centers between January 2018 and August 2025. Eligible participants had documented dates for both DRE diagnosis and phase 1 video-electroencephalography evaluation. Earlier evaluation improves opportunities for seizure control and enables comprehensive care, optimizing outcomes even when surgery is not performed, The patients were grouped according to whether presurgical evaluation occurred within 1 year of DRE diagnosis or at least 1 year afterward. Multivariable logistic regression was used to assess the association between evaluation timing and seizure outcomes after adjustment for etiology, seizure type, neuroimaging, and surgical factors. The analysis included 1310 children with DRE, of whom 55% completed presurgical evaluation within 1 year of diagnosis and 45% underwent evaluation after at least 1 year. The participants were 75% White, 21% Hispanic or Latino, and 52% boys. In total, 69% of the participants had magnetic resonance imaging (MRI)-visible lesions, and 52% had abnormal neurologic examination findings. Mean ages were 4.8 years at seizure onset, 7.6 years at DRE diagnosis, and 9.4 years at presurgical evaluation. Clinical presentation differed according to evaluation timing. Children with MRI-visible lesions were more likely to undergo evaluation within 1 year than those without lesions on MRI (OR, 1.65; 95% CI, 1.30-2.08). Focal seizures (OR, 2.80; 95% CI, 2.13-3.70) and normal neurologic examination findings (OR, 1.86; 95% CI, 1.49-2.33) were also associated with shorter DRE-to-evaluation intervals. Structural congenital and acquired etiologies were associated with shorter intervals, whereas genetic etiologies were associated with longer intervals (OR, 1.73; 95% CI, 1.30-2.32). Surgery was performed in 66% of children in both evaluation groups. However, surgical intent differed significantly according to evaluation timing. Children evaluated within 1 year were more likely to undergo surgery with definitive intent (OR, 2.60; 95% CI, 1.98-3.43), whereas those evaluated at least 1 year after DRE diagnosis were more likely to undergo palliative procedures. Callosotomy was performed in 14% vs 8% of children and neuromodulation in 38% vs 16% of children in the longer- vs shorter-interval groups, respectively. Among the 868 patients who underwent surgery, 624 had available seizure outcome data. Seizure freedom was achieved by 53% of children evaluated within 1 year compared with 27% of those evaluated at least 1 year after DRE diagnosis (OR, 3.04; 95% CI, 2.17-4.29; P <.01). A greater proportion of children in the early evaluation group also achieved more than 50% seizure reduction compared with those in the later evaluation group (79% vs 67%). After adjustment for potential confounding variables, evaluation at least 1 year after DRE diagnosis remained independently associated with lower odds of seizure freedom (OR, 0.59; 95% CI, 0.35-1.00; P =.0497), corresponding to 41% lower odds compared with evaluation within 1 year. A sensitivity analysis including all 868 surgical patients showed similar findings. Children evaluated at least 1 year after DRE diagnosis had 46% lower odds of seizure freedom than those evaluated within 1 year (OR, 0.54; 95% CI, 0.34-0.87; P =.01). In an analysis of timing variables, each additional year between DRE diagnosis and phase 1 evaluation was associated with an 18% reduction in the odds of seizure freedom (OR, 0.82 per year; 95% CI, 0.75-0.90; P <.01). In contrast, total epilepsy duration from seizure onset to surgical evaluation was not significantly associated with seizure outcomes (OR, 0.98 per year; 95% CI, 0.93-1.02; P =.29). Study limitations include the lack of predefined comparative groups and standardized evaluation or surgical approaches across centers, limited information about the rationale for individual procedures and structural abnormalities, incomplete surgical outcome data, and the absence of postsurgical neuropsychological outcomes. “Earlier evaluation improves opportunities for seizure control and enables comprehensive care, optimizing outcomes even when surgery is not performed,” the study authors concluded. References: Samanta D, Caraway AR, Knox AT, et al. Delayed surgical evaluation after drug-resistant epilepsy diagnosis worsens outcomes in children: a multicenter study. Neurol Clin Pract. 2026;16:e200641. doi:10.1212/CPJ.0000000000200641