The emergence of improved methods of presurgical diagnostic imaging is potentially leading to better outcomes for paediatric epilepsy patients undergoing surgery, according to a new study.
Published in the medical journal Epilepsia, the new study from the Hospital for Sick Children in Toronto aimed to examine the effectiveness of a recent change in imaging practice on epilepsy surgery outcomes in a tertiary paediatric epilepsy surgery centre.
Since 2008, many presurgical diagnostic imaging evaluations for medically refractory focal epilepsy have shifted to include high-resolution scans using 3T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose–positron emission tomography (FDG-PET) imaging in selected patients.
In order to assess the impact of this new practice, applied to patients with normal or subtle changes on MRI or discordant diagnostic tests, the researchers examined patient characteristics, surgical variables and seizure-free surgical outcomes among individuals analysed with the new or old practice, with trends in seizure-free outcomes over time also assessed.
It was shown that there was a trend for increased abnormal MRI results and increased utilisation of FDG-PET techniques with new relative to old practice. with no significant differences in the use of invasive monitoring or different types of surgery.
During the period in which the old practice was used, there was no statistically significant change in the yearly trend of seizure-free outcomes, but the change in practice in 2008 was associated with a significant improvement in seizure freedom.
The use of the new practice was associated with a significant positive trend in yearly seizure-free outcomes after adjusting for factors such as the age at seizure onset, the type of surgery in question and the form of imaging used.
The study concluded: “We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimising and improving presurgical diagnostic imaging evaluation to improve surgical outcome.”
Posted by Bob Jones