Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia-Related Epilepsy

Authors

Nathan T. Cohen, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA ncohen@cnmc.org.
Phat Chang, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Xiaozhen You, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Anqing Zhang, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Kathryn A. Havens, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Chima O. Oluigbo, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Matthew T. Whitehead, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Taha Gholipour, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
William D. Gaillard, Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.

Document Type

Journal Article

Publication Date

8-19-2022

Journal

Neurology

DOI

10.1212/WNL.0000000000201033

Abstract

BACKGROUND AND OBJECTIVES: Focal cortical dysplasia is the most common cause of surgically-remediable epilepsy in children. Little is known about the risk factors for the timing and development of pharmacoresistance in this population. This study sought to evaluate the prevalence and risk factors for pharmacoresistance in pediatric FCD-related epilepsy. METHODS: In this retrospective single-center cohort design, patients were identified from search of centralized radiology report database and a central epilepsy surgical database. Inclusion criteria consisted of: 3T MRI-confirmed FCD from January, 2011 to January, 2020; ages 0 days to 22 years at MRI; at least 18 months of documented follow-up after MRI, unless had single seizure or incidentally discovered FCD. Records were excluded if there was dual pathology (except for mesial temporal sclerosis), hemimegalencephaly, or tuberous sclerosis complex present in imaging or history. RESULTS: One hundred forty-three patients with confirmed FCD met inclusion criteria. One hundred twenty-four children had epilepsy (87% of FCD patients) with median age of seizure onset 2.7 years (IQR 0.75-6 years, range 0 to 17 years). Twelve children (8.5%) had a single lifetime seizure (provoked or unprovoked) or recurrent provoked seizures. Seven children (4.9%) had incidental FCD. Ninety-two patients (74%) of those with epilepsy met criteria for pharmacoresistance. Of children with epilepsy of all types, 93 children (75%) were seizure-free at the last visit; Eighty-two patients underwent epilepsy surgery, of whom 59 (72%) achieved seizure freedom. 7% (9/124) achieved seizure freedom with a second ASM, and 5.6% (7/124) with a third or more ASMs. Failure of only one antiseizure medication is associated with enormous increased incidence and earlier development of pharmacoresistance (OR 346, 95% CI 19.6-6100). Cox regression showed FCD lobar location, pathologic subtype, and age of seizure onset are not. CONCLUSIONS: Failure of one antiseizure medication is associated with substantial risk of pharmacoresistance. These data support an operational re-definition of pharmacoresistance, for surgical planning, in FCD-related epilepsy to the failure of one antiseizure medication, and support early, potentially curative surgery to improve outcomes in this patient population.

APA Citation

Cohen, Nathan T.; Chang, Phat; You, Xiaozhen; Zhang, Anqing; Havens, Kathryn A.; Oluigbo, Chima O.; Whitehead, Matthew T.; Gholipour, Taha; and Gaillard, William D., "Prevalence and Risk Factors for Pharmacoresistance in Children With Focal Cortical Dysplasia-Related Epilepsy" (2022). GW Authored Works. Paper 1463.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1463

Department

Pediatrics