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

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

doi:10.1111/epi.17021

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

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

Neurology

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English (US)
Pages (from-to)	2707-2718
Number of pages	12
Journal	Epilepsia
Volume	62
Issue number	11
DOIs	https://doi.org/10.1111/epi.17021
State	Published - Nov 2021

Keywords

hemispherectomy
hemispherotomy
seizure outcomes
technique

ASJC Scopus subject areas

Neurology
Clinical Neurology

Access to Document

10.1111/epi.17021

Cite this

Fallah, A., Lewis, E., Ibrahim, G. M., Kola, O., Tseng, C. H., Harris, W. B., Chen, J. S., Lin, K. M., Cai, L. X., Liu, Q. Z., Lin, J. L., Zhou, W. J., Mathern, G. W., Smyth, M. D., O'Neill, B. R., Dudley, R. W. R., Ragheb, J., Bhatia, S., Delev, D., ... Weil, A. G. (2021). 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, 62(11), 2707-2718. https://doi.org/10.1111/epi.17021

Fallah, A, Lewis, E, Ibrahim, GM, Kola, O, Tseng, CH, Harris, WB, Chen, JS, Lin, KM, Cai, LX, Liu, QZ, Lin, JL, Zhou, WJ, Mathern, GW, Smyth, MD, O'Neill, BR, Dudley, RWR, Ragheb, J, Bhatia, S, Delev, D, Ramantani, G, Zentner, J, Wang, AC, Dorfer, C, Feucht, M, Czech, T, Bollo, RJ, Issabekov, G, Zhu, H, Connolly, M, Steinbok, P, Zhang, JG, Zhang, K, Hidalgo, ET, Weiner, HL, Wong-Kisiel, L, Lapalme-Remis, S, Tripathi, M, Sarat Chandra, P, Hader, W, Wang, FP, Yao, Y, Champagne, PO, Brunette-Clément, T, Guo, Q, Li, SC, Budke, M, Pérez-Jiménez, MA, Raftopoulos, C, Finet, P, Michel, P, Schaller, K, Stienen, MN, Baro, V, Cantillano Malone, C, Pociecha, J, Chamorro, N, Muro, VL, von Lehe, M, Vieker, S, Oluigbo, C, Gaillard, WD, Al-Khateeb, M, Al Otaibi, F, Krayenbühl, N, Bolton, J, Pearl, PL & Weil, AG 2021, '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, vol. 62, no. 11, pp. 2707-2718. https://doi.org/10.1111/epi.17021

@article{6607587e545646ce9e9d50addd76effe,

title = "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",

abstract = "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.",

keywords = "hemispherectomy, hemispherotomy, seizure outcomes, technique",

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

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy",

year = "2021",

month = nov,

doi = "10.1111/epi.17021",

language = "English (US)",

volume = "62",

pages = "2707--2718",

journal = "Epilepsia",

issn = "0013-9580",

publisher = "Wiley-Blackwell",

number = "11",

}

TY - JOUR

T1 - Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy

T2 - A post hoc analysis of the HOPS study

AU - Fallah, Aria

AU - Lewis, Evan

AU - Ibrahim, George M.

AU - Kola, Olivia

AU - Tseng, Chi Hong

AU - Harris, William B.

AU - Chen, Jia Shu

AU - Lin, Kao Min

AU - Cai, Li Xin

AU - Liu, Qing Zhu

AU - Lin, Jiu Luan

AU - Zhou, Wen Jing

AU - Mathern, Gary W.

AU - Smyth, Matthew D.

AU - O'Neill, Brent R.

AU - Dudley, Roy W.R.

AU - Ragheb, John

AU - Bhatia, Sanjiv

AU - Delev, Daniel

AU - Ramantani, Georgia

AU - Zentner, Josef

AU - Wang, Anthony C.

AU - Dorfer, Christian

AU - Feucht, Martha

AU - Czech, Thomas

AU - Bollo, Robert J.

AU - Issabekov, Galymzhan

AU - Zhu, Hongwei

AU - Connolly, Mary

AU - Steinbok, Paul

AU - Zhang, Jian Guo

AU - Zhang, Kai

AU - Hidalgo, Eveline Teresa

AU - Weiner, Howard L.

AU - Wong-Kisiel, Lily

AU - Lapalme-Remis, Samuel

AU - Tripathi, Manjari

AU - Sarat Chandra, Poodipedi

AU - Hader, Walter

AU - Wang, Feng Peng

AU - Yao, Yi

AU - Champagne, Pierre Olivier

AU - Brunette-Clément, Tristan

AU - Guo, Qiang

AU - Li, Shao Chun

AU - Budke, Marcelo

AU - Pérez-Jiménez, Maria Angeles

AU - Raftopoulos, Christian

AU - Finet, Patrice

AU - Michel, Pauline

AU - Schaller, Karl

AU - Stienen, Martin N.

AU - Baro, Valentina

AU - Cantillano Malone, Christian

AU - Pociecha, Juan

AU - Chamorro, Noelia

AU - Muro, Valeria L.

AU - von Lehe, Marec

AU - Vieker, Silvia

AU - Oluigbo, Chima

AU - Gaillard, William D.

AU - Al-Khateeb, Mashael

AU - Al Otaibi, Faisal

AU - Krayenbühl, Niklaus

AU - Bolton, Jeffrey

AU - Pearl, Phillip L.

AU - Weil, Alexander G.

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

KW - hemispherectomy

KW - hemispherotomy

KW - seizure outcomes

KW - technique

UR - http://www.scopus.com/inward/record.url?scp=85114689693&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85114689693&partnerID=8YFLogxK

U2 - 10.1111/epi.17021

DO - 10.1111/epi.17021

M3 - Article

C2 - 34510448

AN - SCOPUS:85114689693

SN - 0013-9580

VL - 62

SP - 2707

EP - 2718

JO - Epilepsia

JF - Epilepsia

IS - 11

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this