New presurgical imaging protocol produces more seizure-free outcomes for pediatric epilepsy patients

Researchers at the University of Toronto have found that pediatric epilepsy patients imaged prior to neurosurgery with a new protocol have a greater chance of being seizure-free following the operation than those imaged using an older protocol.

Their study posted ahead of print Dec. 30 in the journal Epilepsia.

The study abstract outlines how, in 2008, physicians planning epilepsy surgery at Toronto’s Hospital for Sick Children began using a new high-resolution epilepsy protocol in patients with normal or subtle changes on MRI or discordant diagnostic tests.

The protocol includes 3T MRI plus combined magnetoencephalography and 18-fluorodeoxyglucose–positron emission tomography (FDG-PET).

For the study, patients were classified based on old or new practice. The research team compared patient characteristics, surgical variables and seizure-free surgical outcome, then assessed the trend in seizure-free outcome over time.

They found that the pre-2008 protocol, which is not described in the abstract, produced no statistically significant change in yearly trend of seizure-free outcome.

After the protocol change, however, they observed an associated significant improvement in seizure-free outcome.

Additionally, during the period in which the new practice was in place, there was a significant positive trend in yearly seizure-free outcome.

This held after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography and FDG-PET.

“We have found an improvement in seizure-free surgical outcome following the change in imaging practice,” write the study authors. “This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome.”