Surgical versus medical treatment for children with epileptic encephalopathy in infancy and early childhood: Results of an international multicenter cohort study in Far-East Asia (the FACE study)

Taisuke Otsuki, Heung Dong Kim, Guoming Luan, Yushi Inoue, Hiroshi Baba, Hirokazu Oguni, Seung Chyul Hong, Shigeki Kameyama, Katsuhiro Kobayashi, Shinichi Hirose, Hitoshi Yamamoto, Shin ichiro Hamano, Kenji Sugai

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective To compare the seizure and developmental outcomes in infants and young children with epileptic encephalopathy who have undergone surgical and medical treatments. Methods An international, multicenter, observational cohort study was undertaken. A total of 317 children aged <6 years, who had frequent disabling seizures despite intensive medical treatments, were registered. Among the enrolled children, 250 were treated medically (medical group), 31 underwent resective surgery (resective group), and 36 underwent palliative surgery [callosotomy (n = 30) or vagal nerve stimulation (n = 6); palliative group] on admission. Seizure and developmental outcomes were obtained for 230 children during the 3-year follow-up period. Cox proportional hazard model was used to adjust for clinical backgrounds among treatment groups when comparing the seizure-free survival rates. Results At the 3-year follow-up, seizure-free survival was 15.7%, 32.1%, and 52.4% in the medical, palliative, and resective groups, respectively. The adjusted hazard ratios for seizure recurrence in the resective and palliative groups versus the medical group were 0.43 (95% CI, 0.21–0.87, P = 0.019) and 0.82 (95% CI, 0.46–1.46, P = 0.50), respectively; the former was statistically significant. Regarding the developmental outcome, the mean DQs in the resective group increased significantly compared to those in the medical group during the follow-up (P < 0.01). As for subgroup analysis, better seizure and development outcomes were demonstrated in the resective group compared to the medical group in children with nonsyndromic epilepsies (those to which no known epilepsy syndromes were applicable). Significance These results suggest that surgical treatments, particularly resective surgeries, are associated with better seizure and developmental outcomes compared with successive medical treatment. The present observations may facilitate the identification of infants and young children with epileptic encephalopathy who could benefit from surgery.

Original languageEnglish
Pages (from-to)449-460
Number of pages12
JournalBrain and Development
Volume38
Issue number5
DOIs
Publication statusPublished - May 1 2016

Keywords

  • Developmental quotient
  • Epilepsy surgery
  • Epileptic encephalopathy
  • Prospective cohort study
  • Seizure outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

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