Complete lesion resection and early surgical intervention are favorable factors for long‐term seizure freedom in drug‐resistant epileptic spasms
TL;DR
The findings suggest that referring children for surgery sooner rather than later can meaningfully improve their chances of living seizure‐free and underscore the importance of achieving complete lesion removal to optimize postoperative seizure control.
Abstract
Abstract Objective Epileptic spasms (ES) in children carry a high risk of neurodevelopmental delay, yet predictors of long‐term surgical outcome remain incompletely defined. This study aimed to evaluate seizure outcomes following epilepsy surgery and to identify independent prognostic factors for postoperative recurrence. Methods This retrospective cohort study included 73 patients (47 males, 64%; median age at surgery: 37 months, IQR: 20–55.5) with drug‐resistant ES who underwent resective or ablative surgery at Guangdong Sanjiu Brain Hospital in China between January 2015 and September 2024, with regular follow‐up at least 12 months after epilepsy surgery. Independent predictors of recurrence were identified using multivariate Cox proportional hazards regression, and Kaplan–Meier analysis was performed to compare seizure‐free survival stratified by seizure duration (SD) and residual lesion status. Results Seizure‐free rates were 75.3% at 1 year and 55.1% at last follow‐up. Mean follow‐up was 61.36 ± 26.10 months (range: 12–132). Among malformation of cortical development (MCD) subtypes, focal cortical dysplasia (FCD) type II demonstrated the highest 5‐year seizure‐free rate (100%), whereas mild MCD (m‐MCD) showed the lowest (33.3%; p = 0.039). On multivariate Cox analysis, residual lesion on postoperative MRI was the strongest independent predictor of recurrence (HR = 5.13; 95% CI: 2.28–11.51; p < 0.001), followed by SD exceeding 36 months (HR = 2.49; 95% CI: 1.17–5.29; p = 0.018). Kaplan–Meier analysis confirmed a twofold difference in 5‐year seizure‐free survival between patients with duration ≤36 versus >36 months (73% vs. 36%; log‐rank p = 0.00069), and significantly better seizure‐free survival in patients without residual lesions (log‐rank p < 0.0001). Significance Complete lesion resection and early surgical intervention (SD ≤36 months) are independently associated with favorable long‐term seizure outcomes in children with drug‐resistant ES. Pathological subtype, particularly FCD type II, further refines prognostic stratification. These findings support prompt surgical referral and underscore the importance of achieving complete lesion removal to optimize postoperative seizure control. Plain Language Summary Some children develop a severe form of epilepsy called epileptic spasms that cannot be controlled with medication. In this study of 73 children who had brain surgery for this condition, more than half remained seizure‐free after 5 years. Children who had surgery earlier—before seizures had continued for 3 years—and those in whom the entire abnormal brain tissue was removed did significantly better in the long run. These findings suggest that referring children for surgery sooner rather than later can meaningfully improve their chances of living seizure‐free.