Pediatric refractory epilepsy: A decision analysis comparing medical versus surgical treatment

Abstract

Objectives To quantify the life expectancy of surgically eligible children with refractory epilepsy comparing two treatment strategies: medical treatment only versus epilepsy surgery. Methods Decision analysis model populated with available parameters from the literature. One- and two-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters. The time horizon was lifetime and the main outcome was life expectancy. Results Across the range of pediatric ages, epilepsy surgery yielded a higher life expectancy. For a cohort of 10-year-old children with refractory epilepsy, the gain in life expectancy with epilepsy surgery (compared to medical treatment only) was 5.9 years for temporal epilepsy and 5.6 years for extratemporal epilepsy. One- and two-way sensitivity analyses and second-order Monte Carlo simulations demonstrated the robustness of results across a wide variation of input parameters. There was no adjustment for quality of life, but we estimated the percentage of life expectancy spent in seizure freedom. For a cohort of 10-year-old patients with refractory epilepsy: (1) in temporal lobe epilepsy, epilepsy surgery yielded 48.9% of life expectancy years in seizure freedom while medical treatment yielded 14.3%; and (2) in extratemporal epilepsy, epilepsy surgery yielded 43.0% of life expectancy years in seizure freedom while medical treatment yielded 14.3%. Significance Epilepsy surgery yields a substantially higher life expectancy than continued medical treatment for surgically eligible children with refractory epilepsy. This conclusion remains robust across a wide range of parameter variations.