Annual Meeting Abstracts: View
(Abst. A.05), 2014
MANAGEMENT OF CHILDREN WITH REFRACTORY EPILEPSY. A DECISION ANALYSIS COMPARING MEDICAL VERSUS SURGICAL TREATMENT
Authors: Iván Sánchez Fernández, Sookee An and Tobias Loddenkemper
Content: Rationale: To quantify the life expectancy of pediatric epilepsy surgery candidates comparing two treatment strategies: medical treatment only versus epilepsy surgery. Methods: Decision analysis model populated with available parameters from the literature. Outcome: life expectancy. Time horizon: lifetime. Results: Across the range of pediatric ages, epilepsy surgery yielded a higher life expectancy than medical treatment only for both patients with temporal and extratemporal lobe epilepsy. For a cohort of 10-year-old children with refractory epilepsy, the gain in life expectancy with epilepsy surgery (compared to medical treatment only) was 5.9 years for temporal epilepsy and 5.6 years for extratemporal epilepsy. One-way and two-way sensitivity analysis demonstrated the robustness of results across a wide range of values in individual parameters. Second-order Monte-Carlo simulations demonstrated the robustness of epilepsy surgery as the preferred strategy considering parameter uncertainty in the literature. There was no adjustment for quality of life but we estimated the percentage of life expectancy spent in seizure freedom for each strategy. For a cohort of 10-year-old patients with refractory epilepsy: 1) in temporal epilepsy, epilepsy surgery yielded 48.9% of life expectancy years in seizure freedom while medical treatment yielded 14.3%; and 2) in extratemporal epilepsy, epilepsy surgery yielded 43% of life expectancy years in seizure freedom while medical treatment yielded 14.3%. Surgical complications were infrequent. Conclusions: Epilepsy surgery yields a substantially higher life expectancy than continued medical treatment for surgically-eligible children with refractory (temporal or extratemporal) epilepsy. This conclusion is robust across a wide range of parameter variations.