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Updated: Nov 21, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Trends in pediatric epilepsy surgery: A lower-middle-income country perspective
Ajay Asranna1, Suresh Babu Pasangulapati1, Ramshekhar Menon1
1R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Insights
Pediatric epilepsy surgery increased from 2000-2014 in India, with earlier evaluations and more extratemporal surgeries. These trends in a lower- and middle-income country (LMIC) mirror those in high-income nations.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Epilepsy Surgery
Background:
- Pediatric epilepsy surgery is a critical treatment option.
- Understanding trends in lower- and middle-income countries (LMICs) is essential for global health equity.
- Tertiary epilepsy centers in LMICs face unique challenges and opportunities.
Purpose of the Study:
- To analyze trends in pediatric epilepsy surgery from 2000 to 2014 at an Indian tertiary center.
- To provide a lower- and middle-income country (LMIC) perspective on the evolution of pediatric epilepsy surgery.
- To identify changes in surgical rates, types of procedures, and patient demographics over time.
Main Methods:
- Retrospective analysis of 463 pediatric epilepsy surgeries performed between 2000 and 2014.
- Patients categorized into three groups based on surgical year: 2000-2004, 2005-2009, and 2010-2014.
- Comparison of surgery rates, types of epilepsy etiologies, age at evaluation, and epilepsy duration before referral.
Main Results:
- A significant increasing trend in the proportion of pediatric epilepsy surgeries was observed.
- The age at evaluation and duration of epilepsy before referral decreased, especially in lower-income groups.
- Extratemporal surgeries doubled, with increased proportions for benign tumors, cortical malformations, and gliosis/atrophy.
Conclusions:
- Pediatric epilepsy surgery shows promising upward trends in LMICs, mirroring global advancements.
- Decreasing age at presurgical evaluation indicates earlier diagnosis and intervention.
- The evolving practice reflects improved access and management strategies in resource-limited settings.
Objective:
To study the trends for pediatric epilepsy surgery between 2000 and 2014 in a tertiary epilepsy surgery center in India in order to gain a lower- and middle-income country (LMIC) perspective.
Methods:
Children aged <18 years and undergoing epilepsy surgery were divided into three groups based on the year that they underwent surgery-group 1: year 2000-2004; group 2: year 2005-2009; and group 3: year 2010-2014. Data including the rate of surgery, type of surgery, and duration of epilepsy before referral were analyzed from the medical records and compared.
Results:
Between 2000 and 2014, 463 pediatric epilepsy surgeries were performed. The proportion of pediatric epilepsy surgeries showed an increasing trend-218 (total 510 surgeries, 42.74%) in group 3, compared with 115 (total 375 surgeries, 30.66%) in group 1 and 130 (total 466 surgeries, 27.9%) in group 2. A significant decrease in the age at evaluation and duration of epilepsy before referral was noted between 2000 and 2014, particularly in patients belonging to the lowest income group. There was a two-fold increase in the number of extratemporal surgeries over time. The proportion of children undergoing surgery for benign tumors, cortical malformations, and gliosis/atrophy showed an upward trend while that for mesial temporal sclerosis did not show an increase.
Significance:
Promising trends in pediatric epilepsy surgery were noted with increasing number of surgeries and decreasing age at presurgical evaluation. Seen from an LMIC perspective, this reflects an evolution in the practice of pediatric epilepsy surgery, mirroring trends in high-income countries.
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