Lesional Magnetic Resonance Imaging Is Associated with Better Outcomes in the Loma Linda University Children's Hospital Experience
Pilar Pichon1, Sanad Batarseh3, Jude Banihani4, Joshua Loeb2, Richard Tang-Wai2, Delphin Sallowm5, David Michelson2, Joy Nichols2, Warren Boling6
1Pediatrics, Loma Linda University Children's Hospital, 2Loma Linda University Children's Hospital, 3Loma Linda University, Department of Neurology, 4California University of Science and Medicine, 5Kaiser Permanente Southern California, 6Neurosurgery, Loma Linda University Medical Center
Objective:
To determine if age at surgery, gender, or the presence of a lesion on MRI are associated with better outcomes in our institution, as determined by the recorded Engel Outcome Classification 2 years post-surgery.
Background:
Age at surgery and gender were identified as determinants of neuropsychological outcomes after epilepsy surgery (Vakharia et al, 2018). In pediatric epilepsy surgery, the UCLA group experience from 1986-2008 (M. Hemp et al, 2010) supported the general concept that clearer identification of lesions and complete resection are linked with better outcomes.
Design/Methods:
45 pediatric patients with refractory epilepsy who were operated from 2016-2021 at a single epilepsy center were dichotomized to good outcome (Engel I, II, III) and poor outcome (Engel IV). Fisher's exact test was used to determine the relationship between outcomes and age at surgery, gender, or a lesional pre-surgical MRI.
Results:
40/45 had Engel I, II, III and 5 had Engel IV. 14 were less than 9 years old (2-20 years; M/SD= 12.36/5.25), 21 males, 36 had lesions identified on MRI. There was no statistically significant difference in age between good and poor outcomes (t=-1.20, p=.236). Using an alpha level of .05, there was no significant association between outcome and age (p=1.00) or gender (p=.652). However the relationship between a lesional pre-surgical MRI and outcome was statistically significant (p=.04) and yielded a moderate effect size (Cramer's V= .354).Thus, a lesional MRI and a good outcome were not independent of each other. This supports the general concept that identification of lesions are associated with better outcomes.
Conclusions:
Thorough phase 1 and 2 evaluations and a conservative approach to surgery are possible factors that contributed to good surgical outcomes. Surgeries were done mostly on patients with concordant data between Video EEG and neuroimaging including MRI, fluorodeoxyglucose [FDG]-PET, and SPECT when applicable. A lesional MRI correlated with good outcome.