How Surgical Interventions Improve Survival Rate in Pediatric Epilepsy: Sandi K. Lam, MD, MBA

WATCH TIME: 6 minutes

"Our study highlights a profound survival benefit associated with epilepsy surgery in children—83% more likely to be alive at the 10-year mark. This underscores the transformative impact surgical interventions can have on the lives of these young patients.”

The long-term survival for pediatric patients with drug-resistant epilepsy has not been completely identified, which may hinder effective health-care decision making. Therefore, researchers recommend conducting further investigations to have a better understanding of the different treatment effects on mortality in this patient population. In a recently published observational cohort study in The Lancet, findings showed that Black and Hispanic pediatric patients and those on Medicaid were less likely to have epilepsy surgery than White patients and those with private insurance, despite treatment being often more effective than medication alone.^1,2

These findings were presented at the 2023 American Epilepsy Society Annual Meeting, held December 1-5, in Orlando, Florida, by lead author Sandi K. Lam, MD, MBA, division chief of pediatric neurosurgery at Ann & Robert H. Lurie Children's Hospital of Chicago. Among 18,292 pediatric patients treated for drug-resistant epilepsy, 10,240 were treated with antiseizure medications (ASMs) only, 5019 received ASMs and vagus nerve stimulation (VNS), and 3033 received ASMs and cranial epilepsy surgery. After 10 years, patients who also had VNS and those who also had cranial surgery were more likely to be alive than the patients who were only taking ASMs, by 35% and 83%, respectively.

Recently, Lam, also the professor of neurological surgery at Northwestern University Feinberg School of Medicine, sat down with NeurologyLive® during the meeting to discuss how cranial epilepsy surgery has emerged as a potential lifesaver for children with drug-resistant epilepsy, as revealed in the study. She talked about the disparities in access to epilepsy surgery as exposed by the study, and how they correlate with race and insurance status. In addition, Lam spoke about how the study underscored the importance of considering surgical interventions not just for seizure control but also for long-term survival in the evolving landscape of epilepsy care.

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REFERENCES
1. Surgery Helps Children with Drug-Resistant Epilepsy Live Longer But Those Who are Black, Hispanic or on Medicaid Less Likely to Get It. News Release. American Epilepsy Society. Published December 1, 2023. Accessed December 4, 2023. https://aesnet.org/about/about-aes/press-room/surgery-helps-children-with-drug-resistant-epilepsy-live-longer-but-those-who-are-black-hispanic-or-on-medicaid-less-likely-to-get-it
2. Zhang L, Hall M, Lam SK. Comparison of long-term survival with continued medical therapy, vagus nerve stimulation, and cranial epilepsy surgery in paediatric patients with drug-resistant epilepsy in the USA: an observational cohort study. Lancet Child Adolesc Health. 2023;7(7):455-462. doi:10.1016/S2352-4642(23)00082-2