We aimed to investigate clinical factors associated with long-term seizure outcomes among pediatric patients with refractory epilepsy who underwent parieto-occipital cortex surgeries, across multiple centers.

Literature on seizure outcomes following parieto-occipital cortex surgeries among pediatric epilepsy patients is sparse and frequently limited by a small sample size, homogeneous patient population, and are often single-center studies. This study utilizes a multicenter design and captures several critical clinical variables that may influence post-surgical outcomes.

This retrospective study drew data from Pediatric Epilepsy Research Consortium Epilepsy Surgery Database between 2018-2024, representing data from 24 centers. Data collected for each patient included demographic data, seizure type and frequency, etiology/pathology, neuroimaging results, previous treatments, seizure localization, type of procedure(s) performed, and seizure outcomes. Patients with fewer than 12 months of follow-up were excluded. Following bivariate analyses, logistic regression models were constructed integrating potential predictors of a favorable seizure outcome, defined as >90% seizure reduction.

115 patients were included, with a mean age of 4.9 ± 4.6 years at first seizure, 10.5 ± 5.6 years at surgery, and 24.0 ± 12.6 months of follow-up. 82.6% of patients had abnormal MRI results, 85.2% received a resective surgery (thermal ablation, lesionectomy and/or lobectomy), and 70.4% achieved favorable seizure outcomes. 49.6% received parietal surgery, 31.3% occipital, and 19.1% both. Right hemisphere surgery (40.9% of patients, p<0.05), resective surgery (p<0.01), tumor etiology (14.8% of patients, p<0.05), and lower age at surgery (p<0.1) were significantly associated with increased odds of favorable seizure outcomes.

To our knowledge, this is the largest multicenter study examining long-term seizure outcomes following pediatric parieto-occipital surgeries. We demonstrated that early, resective surgeries in the non-dominant hemisphere are associated with favorable seizure outcomes. Tumor etiology may also correlate with better seizure outcomes relative to other etiologies.