Epilepsy Surgery vs Medical Management for Pediatric Drug-Resistant Focal Epilepsy

For a 10-year-old US payer model of pediatric drug-resistant focal epilepsy with a <3 cm-cubed seizure focus, both MRgLITT and open resection improve lifetime outcomes versus medical care.

• Why it matters: Drug-resistant focal epilepsy affects about 30% of children and is linked to excess mortality, neurodevelopmental impairment, and high costs, yet procedure choice between surgery types is unclear.
• What they did: A lifetime Markov decision model compared best medical management, open resection, and MRgLITT from a US healthcare payer perspective, using published systematic reviews and meta-analyses; outcomes were cost per quality-adjusted life year gained.
• The result: MRgLITT produced 22.64 QALYs at $120,943 and open resection 22.62 QALYs at $121,649 versus medical management’s 19.00 QALYs at $127,465, with a 4.6-year survival advantage for both; MRgLITT was optimal in 50.3% of iterations and open resection in 38.3%, and etiology favored MRgLITT for focal cortical dysplasia and mesial temporal sclerosis but open resection for tumor- and cavernoma-related epilepsy.

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