DAY 2 | Complex Surgical Procedures and Associated Syndromes May Delay Surgery for Children with Epilepsy

A retrospective analysis of children who underwent surgical procedures for epilepsy at the University of California, Los Angeles (UCLA) Mattel Children’s Hospital showed that underlying syndromes and the type of planned surgical procedure may lead to surgical delays in this population.

Previous research has shown that a longer duration of epilepsy before surgery is a predictor of poor neurodevelopmental outcomes in children and may result in reduced rates of seizure freedom post-surgery (Ramantani G et al. Neurosurgery 2018; 83:93–103). Factors that cause delay during the presurgical evaluation may vary widely among different institutions and patient populations. Sotaro Kanai, MD, PhD, a postdoctoral scholar in the Division of Pediatric Neurology at UCLA, and colleagues designed a retrospective study to identify factors that may contribute to surgical delays in children with epilepsy, who can benefit from timely interventions. The study cohort included 137 consecutive pediatric patients with a mean age of 9.4 years at the time of treatment, who underwent epilepsy surgery at the UCLA hospital between 2021 and 2025. More than half of the included patients (57%) had focal epilepsy, and almost 15% of the participants had a diagnosis of Lennox-Gastaut syndrome. 

The participants underwent various types of surgical procedures, including hemispherectomy, focal resection, callosotomy, and neuromodulation. A retrospective review of their charts revealed a mean surgical delay of 6.3 years across the cohort, defined as the time from seizure onset to the first surgery performed to treat the epilepsy. 

In analyzing the patient-specific characteristics that could delay surgical procedures, the researchers found that sociodemographic factors were not independently associated with surgical delay. However, the type of epilepsy diagnosis emerged as a strong predictor of delays in the UCLA cohort. Kaplan-Meier survival analysis revealed that children with Lennox-Gastaut syndrome experienced substantially longer surgical delays compared to those with infantile spasms and generalized epilepsy. Patients with Lennox-Gastaut syndrome often undergo complex procedures, which require extensive imaging and invasive monitoring. Although additional research is needed to shed light on the specific reasons for delaying surgery in children with this condition, the authors noted that “the results indicate the necessity for early identification and targeted referral for high-risk groups, such as those with Lennox-Gastaut syndrome, to reduce surgical delay and contribute to beneficial long-term outcomes.”

Children with structural etiology also experienced longer delays compared to those with genetic causes and those in other etiological categories, however, those differences did not reach statistical significance. 

In terms of surgical procedure type, patients undergoing neuromodulation experienced longer delays compared to those treated with other surgical approaches. Various factors, including patient and family misconceptions, systemic barriers, and knowledge gaps may contribute to delays in the use of neuromodulation in the treatment of epilepsy. This procedure requires extensive presurgical evaluation and is often employed as a second-line or palliative treatment option after the failure of pharmacotherapy. Although the causes underlying surgical delays are multifactorial and may depend on institutional approaches, identifying the potential contributors to delays is a crucial step toward more effective referrals and improved treatment outcomes in pediatric epilepsy.