J Neurosurg Pediatr. 2026 Apr 24:1-12. doi: 10.3171/2025.12.PEDS25560. Online ahead of print.
ABSTRACT
OBJECTIVE: Several studies have reported that a shorter duration of epilepsy is associated with better surgical seizure outcomes; however, most of these findings have been based on adult populations. Data on children remain limited, and it is still unclear whether the duration of drug-resistant epilepsy (DRE) or the duration of overall epilepsy is more associated with seizure outcomes. The primary research question of this study focused on the association between total epilepsy duration and seizure outcome at the 2-year follow-up, whereas the secondary research question centered on the role of DRE duration.
METHODS: The authors conducted a retrospective analysis of pediatric patients with epilepsy who underwent resective surgery between 2002 and 2022 at a single institution. Seizure outcome data were obtained at the 2-year follow-up after the last surgery. A subgroup analysis of patients with a known time for DRE onset was performed. Predictors of seizure recurrence were assessed using multiple adjusted logistic regression models, accounting for multicollinearity.
RESULTS: A total of 239 patients underwent epilepsy surgery in the study period. Among them, 154 patients (71.0% of those with DRE) had an identifiable time of DRE onset. Compared to those with ongoing seizures, seizure-free patients had a significantly shorter median duration of epilepsy (4.25 vs 5.98 years, p < 0.001) and a shorter median duration of DRE (1.75 vs 3.13 years, p < 0.001). Due to the multicollinearity between time-related variables, epilepsy duration and DRE duration were entered into separate models for adjusted logistic regression. In the epilepsy duration-based models, a longer epilepsy duration was associated with seizure recurrence (OR 1.10, 95% CI 1.03-1.18, p = 0.008). In the DRE-based models, a longer DRE duration was associated with worse outcomes (OR 1.20, 95% CI 1.00-1.43, p = 0.045), while epilepsy duration was not statistically significant.
CONCLUSIONS: In this unselected population-based, pediatric, resective epilepsy surgery cohort, longer epilepsy duration is associated with worse seizure outcomes. Similarly, a prolonged duration of DRE was correlated with worse seizure outcomes. The findings emphasize the importance of early surgical referrals. Future multicenter studies are warranted to further clarify the relative prognostic value of DRE duration versus total epilepsy duration and to guide evidence-based criteria for surgical timing in children with epilepsy.
PMID:42030572 | DOI:10.3171/2025.12.PEDS25560
