Dataset Information

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.

ABSTRACT:

Objective

This 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.

Methods

We 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-event method and calculated using the Kaplan-Meier survival method.

Results

Data for 672 participants across 23 centers were collected on the specific hemispherotomy approach. Of these, 72 (10.7%) underwent vertical parasagittal hemispherotomy 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.

Significance

This 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 a randomized clinical trial, are required to determine whether a vertical approach to hemispheric surgery provides superior long-term seizure outcomes.

SUBMITTER: Fallah A

PROVIDER: S-EPMC9290517 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Publications

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.

Fallah Aria A Lewis Evan E Ibrahim George M GM Kola Olivia O Tseng Chi-Hong CH Harris William B WB Chen Jia-Shu JS Lin Kao-Min KM Cai Li-Xin LX Liu Qing-Zhu QZ Lin Jiu-Luan JL Zhou Wen-Jing WJ Mathern Gary W GW Smyth Matthew D MD O'Neill Brent R BR Dudley Roy W R RWR Ragheb John J Bhatia Sanjiv S Delev Daniel D Ramantani Georgia G Zentner Josef J Wang Anthony C AC Dorfer Christian C Feucht Martha M Czech Thomas T Bollo Robert J RJ Issabekov Galymzhan G Zhu Hongwei H Connolly Mary M Steinbok Paul P Zhang Jian-Guo JG Zhang Kai K Hidalgo Eveline Teresa ET Weiner Howard L HL Wong-Kisiel Lily L Lapalme-Remis Samuel S Tripathi Manjari M Sarat Chandra Poodipedi P Hader Walter W Wang Feng-Peng FP Yao Yi Y Champagne Pierre-Olivier PO Brunette-Clément Tristan T Guo Qiang Q Li Shao-Chun SC Budke Marcelo M Pérez-Jiménez Maria Angeles MA Raftopoulos Christian C Finet Patrice P Michel Pauline P Schaller Karl K Stienen Martin N MN Baro Valentina V Cantillano Malone Christian C Pociecha Juan J Chamorro Noelia N Muro Valeria L VL von Lehe Marec M Vieker Silvia S Oluigbo Chima C Gaillard William D WD Al-Khateeb Mashael M Al Otaibi Faisal F Krayenbühl Niklaus N Bolton Jeffrey J Pearl Phillip L PL Weil Alexander G AG

Epilepsia 20210912 11

<h4>Objective</h4>This 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.<h4>Methods</h4>We 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 modeli ...[more]

PMID: 34510448

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Dataset Information

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.

Objective

Methods

Results

Significance

Publications

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.

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