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

Publication

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

Journal Paper/Review - Sep 12, 2021

Weil Alexander G, Finet Patrice, Raftopoulos Christian, Pérez-Jiménez Maria Angeles, Budke Marcelo, Li Shao-Chun, Guo Qiang, Brunette-Clément Tristan, Champagne Pierre-Olivier, Yao Yi, Wang Feng-Peng, Hader Walter, Sarat Chandra Poodipedi, Tripathi Manjari, Lapalme-Remis Samuel, Michel Pauline, Schaller Karl, Stienen Martin N., Pearl Phillip L, Bolton Jeffrey, Krayenbühl Niklaus, Al Otaibi Faisal, Al-Khateeb Mashael, Gaillard William D, Oluigbo Chima, Vieker Silvia, von Lehe Marec, Muro Valeria L, Chamorro Noelia, Pociecha Juan, Cantillano Malone Christian, Baro Valentina, Wong-Kisiel Lily, Weiner Howard L, Hidalgo Eveline Teresa, O'Neill Brent R, Smyth Matthew D, Mathern Gary W, Zhou Wen-Jing, Lin Jiu-Luan, Liu Qing-Zhu, Cai Li-Xin, Lin Kao-Min, Chen Jia-Shu, Harris William B, Tseng Chi-Hong, Kola Olivia, Ibrahim George M, Lewis Evan, Dudley Roy W R, Ragheb John, Bhatia Sanjiv, Zhang Kai, Zhang Jian-Guo, Steinbok Paul, Connolly Mary, Zhu Hongwei, Issabekov Galymzhan, Bollo Robert J, Czech Thomas, Feucht Martha, Dorfer Christian, Wang Anthony C, Zentner Josef, Ramantani Georgia, Delev Daniel, Fallah Aria

Citation

Weil A, Finet P, Raftopoulos C, Pérez-Jiménez M, Budke M, Li S, Guo Q, Brunette-Clément T, Champagne P, Yao Y, Wang F, Hader W, Sarat Chandra P, Tripathi M, Lapalme-Remis S, Michel P, Schaller K, Stienen M, Pearl P, Bolton J, Krayenbühl N, Al Otaibi F, Al-Khateeb M, Gaillard W, Oluigbo C, Vieker S, von Lehe M, Muro V, Chamorro N, Pociecha J, Cantillano Malone C, Baro V, Wong-Kisiel L, Weiner H, Hidalgo E, O'Neill B, Smyth M, Mathern G, Zhou W, Lin J, Liu Q, Cai L, Lin K, Chen J, Harris W, Tseng C, Kola O, Ibrahim G, Lewis E, Dudley R, Ragheb J, Bhatia S, Zhang K, Zhang J, Steinbok P, Connolly M, Zhu H, Issabekov G, Bollo R, Czech T, Feucht M, Dorfer C, Wang A, Zentner J, Ramantani G, Delev D, Fallah A. 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. Epilepsia 2021

Type

Journal Paper/Review (English)

Journal

Epilepsia 2021

Publication Date

Sep 12, 2021

Issn Electronic

1528-1167

Brief description/objective

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.