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. 2025 Jul 28.
doi: 10.1111/epi.18558. Online ahead of print.

Trends in epilepsy surgery in Italy before and after the COVID-19 pandemic: A nationwide study

Giuseppe Didato  1 , Federico Vigevano  2 , Laura Tassi  3 , Renzo Guerrini  4   5 , Marco de Curtis  1 , Luca De Palma  6 , Giancarlo Di Gennaro  7 , Lino Nobili  8   9 , Matteo Martinoni  10   11 , Stefano Meletti  12   13 , Domenica Battaglia  14   15 , Elisabetta Cesaroni  16 , Roberta Vittorini  17 , Laura Grisotto  18 , Giuseppe d'Orsi  19 , Robertino Dilena  20 , Valeria Pingue  21   22 , Antonio Nardone  21   22 , Federica Ranzato  23 , Claudio Zucca  24 , Paolo Bonanni  25 , Pietro Mattioli  9   26 , Gianpiero Tamburrini  27 , Michela Quintiliani  14 , Michele Luzi  28 , Roberto Trignani  28 , Francesca Torta  17 , Giovanni Morana  29   30 , Matteo Pugnaghi  13 , Anna Elisabetta Vaudano  12   13 , Francesca Bisulli  11   31 , Elena Pasini  11 , Alessandro Consales  9   32 , Giulia Nobile  8 , Vincenzo Esposito  7   33 , Pier Paolo Quarato  7 , Elena Freri  34 , Carlo Efisio Marras  35 , Flavio Giordano  4   36 , Veronica Pelliccia  3 , Laura Castana  3 , Nicola Specchio  6   37 , Umberto Costantino  19 , Mauro Pluderi  38 , Michele Rizzi  39 , Diana Polo  23 , Stefania Zambrano  24 , Alberto Danieli  25 , Flavio Villani  26 , Carmen Barba  4   5 ; Italian Epilepsy Surgery Collaborative Group
Collaborators, Affiliations

Trends in epilepsy surgery in Italy before and after the COVID-19 pandemic: A nationwide study

Giuseppe Didato et al. Epilepsia. .

Abstract

Objective: To study the current practice of epilepsy surgery in Italy and the relative impact of coronavirus disease 2019 (COVID-19) pandemic on it.

Methods: We launched a survey through the Italian National Virtual Epilepsy Institute, to identify centers with epilepsy surgery programs and collect data on the current preoperative and surgical practices. We reported changes in surgical volumes and complications and seizure outcomes between 2018 and 2022, that is, before and after the COVID-19 pandemic in Italy.

Results: A total of 21 of the 26 surveyed centers (80.7%) responded. Eleven centers (52.4%) reported having an established epilepsy surgery program, with most performing complex procedures, such as multilobar, disconnective, and hemispheric interventions. However, only a few carry out minimally invasive surgeries. Presurgical evaluation protocols vary across centers, but in keeping with international standards. Globally, 618 surgeries were performed in children and 621 in adults (total 1239) between 2018 and 2022. The most frequent type of surgery was unilobar extratemporal lobectomy for children (38.7%, p < 0.0001) and unilobar temporal lobectomy for adults (63.3%, p < 0.0001). Hemispheric surgeries were more frequent in children than in adults (11.5% vs 2.1%, p = 0.001), whereas interventions in unrevealing magnetic resonance (MRI) cases were more frequent in adults than in children (p = 0.030). At the onset of COVID-19outbreak in Italy (March 2020), we observed a significant decrease in the total number of operations compared to 2019, especially for hemispheric interventions (p = 0.027). Surgical volumes resumed in 2021, particularly for temporal lobe epilepsies and in adult cohorts. Surgical complications increased significantly in 2020 (Incidence Rate Ratio [IRR] = 13.13), whereas seizure outcome did not change significantly between 2018 and 2022.

Significance: Advanced pre- and postsurgical evaluation protocols are currently implemented across Italy, with a great variability between centers. Starting in 2021, epilepsy surgery volumes have regained their pre-pandemic levels, albeit with a slight loss of complexity, whereas seizure outcome has remained stable.

Keywords: adults; children; outcome; surgical volumes; survey.

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References

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