Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy: A post hoc analysis of the HOPS study
| Autor: | Marcelo Budke, Brent R. O'Neill, Lily C. Wong-Kisiel, Anthony C. Wang, Chima O. Oluigbo, Feng-Peng Wang, Daniel Delev, Chi-Hong Tseng, Poodipedi Sarat Chandra, Martha Feucht, Mary B. Connolly, Faisal Al Otaibi, Yi Yao, Manjari Tripathi, Olivia Kola, Noelia Chamorro, Martin N. Stienen, Jiuluan Lin, Walter Hader, John Ragheb, Valentina Baro, Qiang Guo, Aria Fallah, Georgia Ramantani, Jia-Shu Chen, Valeria L. Muro, Matthew D. Smyth, Qingzhu Liu, George M. Ibrahim, Galymzhan Issabekov, Eveline Teresa Hidalgo, Karl Lothard Schaller, William D. Gaillard, Wenjing Zhou, Evan J. H. Lewis, Maria Angeles Pérez-Jiménez, Roy W. R. Dudley, Alexander G. Weil, Tristan Brunette-Clément, Marec von Lehe, Jeffrey Bolton, Jianguo Zhang, William B. Harris, Sanjiv Bhatia, Christian Raftopoulos, Josef Zentner, Shao-Chun Li, Niklaus Krayenbühl, Lixin Cai, Christian Dorfer, Mashael Al-Khateeb, Pierre-Olivier Champagne, Kai Zhang, Thomas Czech, Robert J. Bollo, Silvia Vieker, Pauline Michel, Paul Steinbok, P. Finet, Christian Cantillano Malone, Gary W. Mathern, Howard L. Weiner, Hongwei Zhu, Samuel Lapalme-Remis, Juan Pociecha, Phillip L. Pearl, Kao-Min Lin |
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| Přispěvatelé: | UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service de neurochirurgie, UCL - (SLuc) Centre du cancer |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Drug Resistant Epilepsy Hemispherectomy medicine.medical_treatment Clinical Trials and Supportive Activities Clinical Sciences hemispherotomy Subgroup analysis Pilot Projects Neurodegenerative Seizures Clinical Research Post-hoc analysis medicine Humans Prospective Studies Child Retrospective Studies hemispherectomy seizure outcomes technique Epilepsy Neurology & Neurosurgery business.industry Hazard ratio Neurosciences Retrospective cohort study Odds ratio Confidence interval Surgery Brain Disorders Treatment Outcome Neurology Cohort Dihydrotachysterol Neurology (clinical) business |
| Zdroj: | Epilepsia, vol 62, iss 11 Epilepsia, Vol. 62, no. 11, p. 2707-2718 (2021) |
| Popis: | ObjectiveThis study was undertaken to determine whether the vertical parasagittal approach or the lateral peri-insular/peri-Sylvian approach to hemispheric surgery is the superior technique in achieving long-term seizure freedom.MethodsWe conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri-insular/peri-Sylvian, or lateral trans-Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time-to-eventmethod andcalculated using the Kaplan-Meier survival method.ResultsData for 672 participants across 23 centers were collected on the specific hemispherotomy approach. Of these, 72 (10.7%) underwent vertical parasagittalhemispherotomy and 600 (89.3%) underwent lateral peri-insular/peri-Sylvian or trans-Sylvian hemispherotomy. Seizure freedom was obtained in 62.4% (95% confidence interval [CI]=53.5%-70.2%) of the entire cohort at 10-year follow-up. Seizure freedom was 88.8% (95% CI=78.9%-94.3%) at 1-year follow-up and persisted at 85.5% (95% CI=74.7%-92.0%) across 5- and 10-year follow-up in the vertical subgroup. In contrast, seizure freedom decreased from 89.2% (95% CI=86.3%-91.5%) at 1-year to 72.1% (95% CI=66.9%-76.7%) at 5-year to 57.2% (95% CI=46.6%-66.4%) at 10-year follow-up for the lateral subgroup. Log-rank test found that vertical hemispherotomy was associated with durable seizure-free progression compared to the lateral approach (p=.01). Patients undergoing the lateral hemispherotomy technique had a shorter time-to-seizure recurrence (hazard ratio=2.56, 95% CI=1.08-6.04, p=.03) and increased seizure recurrence odds (odds ratio=3.67, 95% CI=1.05-12.86, p=.04) compared to those undergoing the vertical hemispherotomy technique.SignificanceThis pilot study demonstrated more durable seizure freedom of the vertical technique compared to lateral hemispherotomy techniques. Further studies, such as prospective expertise-based observational studies or arandomized clinical trial, are required to determine whether a vertical approach to hemispheric surgery provides superior long-term seizure outcomes. |
| Databáze: | OpenAIRE |
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