Evidence map›Paper›PMID 42545811›Full record

ArticleEpilepsia2026

Effect of time to palliative epilepsy surgery on outcomes.

Robert M Crutcher, David E Horvat, Avery R Caraway, Kristen H Arredondo, Taylor J Abel, Nitin Agarwal, Allyson L Alexander, Dallas Michael Armstrong, Kurtis I Auguste, Danilo Bernardo and 25 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

35 authors.

Robert M CrutcherDepartment of Child and Adolescent Neurology, Nemours Children's Health, Jacksonville, Florida, USA.ORCID https://orcid.org/0009-0006-7508-196X
David E HorvatDepartment of Neurology, Alexander T. Augusta Military Medical Center, Ft. Belvoir, Virginia, USA.ORCID https://orcid.org/0000-0003-2400-122X
Avery R CarawayDepartment of Neurology, Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA.ORCID https://orcid.org/0009-0008-2957-9227
Kristen H ArredondoDepartment of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.ORCID https://orcid.org/0000-0001-6562-8331
Taylor J AbelDepartment of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.ORCID https://orcid.org/0000-0002-5089-460X
Nitin AgarwalDivision of Pediatric Epilepsy, Minnesota Epilepsy Group, Roseville, Minnesota, USA.ORCID https://orcid.org/0000-0002-4684-8774
Allyson L AlexanderDivision of Pediatric Neurosurgery, Children's Hospital Colorado; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA.ORCID https://orcid.org/0000-0003-4928-3921
Dallas Michael ArmstrongDepartment of Pediatrics and Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.ORCID https://orcid.org/0000-0002-8395-5587
Kurtis I AugusteDepartment of Neurosurgery, University of California, San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA.ORCID https://orcid.org/0000-0002-1607-0818
Danilo BernardoDepartment of Neurology, Division of Epilepsy, University of California, San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0003-1077-2963
Jeffrey BoltonDepartment of Neurology, Harvard Medical School, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0003-2949-8722
David BondaDepartment of Neurosurgery, Cedars-Sinai, Los Angeles, California, USA.ORCID https://orcid.org/0009-0000-3362-0466
Dewi Frances Depositario-CabacarDepartment of Neurology, Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.ORCID https://orcid.org/0009-0003-3210-9860
Krista EschbachSection of Child Neurology, Department of Pediatrics, University of Colorado Anschutz Medical Campus Children's Hospital Colorado, Aurora, Colorado, USA.ORCID https://orcid.org/0000-0002-4249-338X
William D GaillardDepartment of Neurology, Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.ORCID https://orcid.org/0000-0001-5709-0033
Aran GrovesDivision of Neurology, OHSU Doernbecher Children's Hospital, Portland, Oregon, USA.
Jason S HauptmanDepartment of Neurosurgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.ORCID https://orcid.org/0000-0002-2035-9876
Pradeep K JavarayeeDepartment of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.ORCID https://orcid.org/0000-0002-1776-1792
Cemal KarakasDepartment of Neurology, Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA.ORCID https://orcid.org/0000-0002-9516-2285
Andrew T KnoxDepartment of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.ORCID https://orcid.org/0000-0001-7792-5384
Jenny J LinDepartment of Pediatric Neurology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Patricia E McGoldrickDepartment of Neurosurgery, St. Luke's/Roosevelt Hospital Center and Beth Israel Medical Center, New York, New York, USA.ORCID https://orcid.org/0000-0003-3381-0635
Derryl J MillerDepartment of Neurology, Specialty Care, Brentwood, Tennessee, USA.ORCID https://orcid.org/0000-0002-4226-4835
Edward John NovotnyDivision of Pediatric Neurology, Department of Neurology, Neurosciences, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.ORCID https://orcid.org/0000-0001-9726-0447
Adam P OstendorfDepartment of Neurology, Nationwide Children's Hospital and Ohio State University, Columbus, Ohio, USA.ORCID https://orcid.org/0000-0002-9994-6650
Pilar D PichonDepartment of Neurology, Children's Hospital of Orange County, Orange, California, USA.ORCID https://orcid.org/0009-0002-7804-8234
Shilpa B ReddyDepartment of Neurology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.ORCID https://orcid.org/0000-0001-7734-773X
Debopam SamantaChild Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.ORCID https://orcid.org/0000-0002-5154-8717
Rani K SinghDepartment of Neurology, Atrium Health, Levine Children's Hospital Charlotte, Charlotte, North Carolina, USA.ORCID https://orcid.org/0000-0001-9343-6070
Janelle L WagnerCollege of Nursing, Department of Pediatrics, and Comprehensive Epilepsy Center, Medical University of South Carolina, Charleston, South Carolina, USA.ORCID https://orcid.org/0000-0003-4610-1504
Steven M WolfDepartment of Neurosurgery, St. Luke's/Roosevelt Hospital Center and Beth Israel Medical Center, New York, New York, USA.ORCID https://orcid.org/0000-0002-7602-3474
Lily C Wong-KisielDepartment of Neurology, Mayo Clinic, Rochester, Minnesota, USA.ORCID https://orcid.org/0000-0002-5306-0862
Fernando N GalanDepartment of Child and Adolescent Neurology, Nemours Children's Health, Jacksonville, Florida, USA.ORCID https://orcid.org/0000-0003-1338-8326
M Scott PerryDepartment of Neurology, Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA.ORCID https://orcid.org/0000-0002-1825-846X
Michael A CilibertoChild Neurology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.ORCID https://orcid.org/0000-0001-8188-7261

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveEpilepsy duration is a modifiable risk factor in the outcome of definitive epilepsy surgery; however, an analogous effect in palliative procedures has not been shown. We reviewed the Pediatric Epilepsy Surgery Database data for an association between epilepsy duration and seizure reduction in palliative procedures.

methodsPatients enrolled between January 2018 and April 2025 who underwent their first epilepsy surgery with palliative intent with 6 months of follow-up were included. Procedures included neuromodulation, corpus callosotomy, hemispherotomy, lesionectomy, and lobectomy where surgical intent was not seizure freedom. Outcomes of seizure freedom, 90% seizure reduction, and 50% seizure reduction were considered at 6-12 months and >12 months from surgery. Duration from epilepsy onset to surgery was compared for patients above and below each outcome threshold at each time point. Logistic regression analysis for the association between epilepsy duration and seizure reduction adjusted for potential confounders including procedure type, etiology, and other clinical factors. Logistic regression analysis was performed on the overall cohort and subgroups of patients with each procedure.

resultsA total of 588 patients were included. Initial univariate analysis suggested that epilepsy duration at time of surgery was significantly associated with seizure freedom and 90% seizure reduction at both 6-12 months and >12 months. After adjusting for confounders, only seizure freedom at >12 months was significantly associated with duration of epilepsy. When individual procedures were considered, only lobectomy was sensitive to duration of epilepsy in multivariate analysis, with significant impacts on >50% and >90% seizure reduction at >12 months. Lesional epilepsy predicted seizure freedom at >12 months. Neuromodulation and corpus callosotomy were less likely to achieve seizure reduction than other procedures. SIGNIFICANCE: We did not find an association between early epilepsy surgery and seizure reduction. This reflects the heterogeneity of our population, including different types of surgical procedures and lesional and nonlesional epilepsies.

Indexed as

EpilepsyNeurosurgical ProceduresPalliative CareTime-to-TreatmentAdolescentChildChild, PreschoolFemaleHumansInfantMaleRetrospective StudiesTime FactorsTreatment DelayTreatment Outcomeepilepsypalliativerefractorysurgery

Identifiers

PMID42545811
PMCPMC13675756

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