The Prevalence and Risk Factors of Coagulopathy in Pediatric Epilepsy Surgery Patients
Condition: Epilepsy in Children; Coagulation and Hemorrhagic Disorders; Epilepsy; Seizure; Antiepileptic Adverse Reaction
MeSH terms: Epilepsy; Seizures; Hemorrhagic Disorders
Study type: Observational

Summary: 
      The hematologic consequences of novel Anti-seizure medications (ASMs) are rarely reported.

      Whether coagulation dysfunctions increase the risk of peri-operative bleeding remains
      controversial.

      The research is performed to investigated the incidence and risk factors of preoperative
      coagulation dysfunction in children undergoing surgery for epilepsy and their impact on
      surgery.
    

Detailed description: 
      Epilepsy is a common disease of the nervous system with severe consequences. Epidemiological
      surveys have shown that the prevalence of epilepsy in China is approximately 0.4-0.7%,
      comprising 7-10 million patients with epilepsy, most of whom are children. Although most
      symptoms of epilepsy can be controlled with the use of anti-seizure medications (ASMs), there
      are still a few patients who cannot achieve satisfactory seizure control with such
      medications or cannot tolerate their side effects, thus requiring surgical treatment.
      Surgical treatment of epilepsy has been recognized as a valuable treatment option for
      carefully selected patients to achieve better seizure control and quality of life. Compared
      to adults, children with epilepsy with indications for surgery usually have a better
      prognosis after surgical treatment. Many children undergoing surgery for epilepsy have a long
      history of using ASMs. Moreover, ASM therapy usually consists of multiple varieties of drugs,
      thereby bringing significant attention to the side effects of ASMs, especially those that may
      be relevant in the perioperative surgical setting.

      ASMs have been associated with multiple adverse effects on platelets and the coagulation
      system. Valproic acid (VPA), one of the most commonly used traditional ASM, has been reported
      to cause multiple hematologic abnormalities, including thrombocytopenia, platelet aggregation
      dysfunction, fibrinogen (FBG) depletion, bone marrow suppression, decreased factor XIII, and
      acquired von Willebrand disease. However, the wide use of novel ASMs in recent decades has
      led to decreased reports of adverse events. The hematologic consequences of these novel ASMs
      or combined therapies are rarely reported. Few studies have suggested that levetiracetam
      (LEV) does not cause clinically significant or relevant hematological disorders.

      Such reported side effects may be more significant in pediatric patients with epilepsy due to
      individual differences in age, weight, and pharmacokinetic action of the body on the drugs.
      The incidence of coagulopathies has been reported to be higher in children than in adults,
      especially hypofibrinogenemia. Nevertheless, whether these coagulation dysfunctions increase
      the risk of peri-operative bleeding remains controversial. Most investigators suggest that
      ASMs, including VPA, are not associated with surgery-related blood loss or transfusion
      requirements. However, a few studies have suggested that considering the extra risk of
      peri-operative bleeding, VPA should be discontinued before surgery.

      This retrospective analysis of 390 children with epilepsy systematically investigated the
      incidence and risk factors of preoperative coagulation dysfunction in children undergoing
      surgery for epilepsy and their impact on surgery, with the objective to provide detailed and
      valuable clinical information.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        The study population were children who were hospitalized between January 2015 and December
        2021 at the Neurosurgery Department of Children's Hospital of Fudan University, including
        non-epileptic children who underwent non-epilepsy neurological surgery by the same surgeon
        and were admitted at the same period for control.

          -  319 patients with epilepsy who administered Anti-seizure Medications (ASMs);

          -  71 patients with epilepsy who were not administered ASMs;

          -  104 non-epileptic children who underwent neurosurgical operations and had never taken
             any ASMs.
      
Keywords: Pediatric; Epilepsy; Surgery; Coagulation Function; Anti-seizure Medications