Publications by authors named "Elysa Widjaja"
Objective: We identified factors associated with computed tomographic (CT) imaging within 24 hours of emergency department (ED) presentation in hospitalized children with severe orbital infections.
Patients And Methods: A multicenter retrospective cohort study was conducted that included children aged 2 months to 18 years between 2009 and 2018 who were admitted to the hospital with severe orbital infections, including periorbital and orbital cellulitis. Multivariable modified Poisson regression was used to identify possible factors associated with receiving a CT scan within 24 hours of ED presentation.
Background And Objectives: Gelastic seizures due to hypothalamic hamartomas (HH) are challenging to treat, in part due to an incomplete understanding of seizure propagation pathways. Although magnetic resonance imaging-guided laser interstitial thermal therapy (MRgLITT) is a promising intervention to disconnect HH from ictal propagation networks, the optimal site of ablation to achieve seizure freedom is not known. In this study, we investigated intraoperative post-ablation changes in resting-state functional connectivity to identify large-scale networks associated with successful disconnection of HH.
View Article and Find Full Text PDFBackground: Hippocampal sclerosis (HS) is a common surgical substrate in adult epilepsy surgery cohorts but variably reported in various pediatric cohorts.
Objective: We aimed to study the epilepsy phenotype, radiological and pathological variability, seizure and neurocognitive outcomes in children with drug-resistant epilepsy and hippocampal sclerosis (HS) with or without additional subtle signal changes in anterior temporal lobe who underwent surgery.
Methods: This retrospective study enrolled children with drug-resistant focal epilepsy and hippocampal sclerosis with or without additional subtle T2-Fluid Attenuated Inversion Recovery (FLAR)/Proton Density (PD) signal changes in anterior temporal lobe who underwent anterior temporal lobectomy with amygdalohippocampectomy.
Aim: To describe the rates of stroke and craniocervical vasculopathy progression in children with posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities (PHACE) syndrome.
Method: A single-center, retrospective natural history study of children with PHACE syndrome. Clinical and sequential neuroimaging data were reviewed to study the characteristics and progression of vasculopathy and calculate the rates of arterial ischemic stroke (AIS) and transient ischemic stroke (TIA).
Article Synopsis
- The study aimed to explore how different initial antibiotic treatments affect the outcomes of hospitalized children with severe orbital infections.
- It analyzed data from 2009 to 2018 from 10 Canadian hospitals, focusing on patients aged 2 months to 18 years who were hospitalized for more than 24 hours.
- Findings revealed that while broad-spectrum antibiotics led to longer hospital stays, they did not impact the likelihood of requiring surgical intervention, indicating a need for more effective antibiotic treatment studies.
Article Synopsis
- A systematic review investigated the impact of social determinants of health (SDOH) on the utilization of epilepsy surgery among pediatric patients with drug-resistant epilepsy (DRE), aiming to uncover factors influencing surgical referral and timing.
- The review analyzed 18 studies from over 4,500 articles and identified that patients who received surgery were predominantly White, privately insured, and had college-educated caregivers, highlighting disparities based on race and socioeconomic status.
- Key findings revealed that Hispanic and non-White patients experienced longer times to surgery referral and lower surgery rates, while private insurance and higher household income were linked to increased surgical use.
Article Synopsis
- The study aimed to assess the quality of life (HRQOL) of parents whose children underwent epilepsy surgery versus those treated with medical therapy over two years.
- Researchers collected data from parents at multiple intervals and adjusted for various factors using a linear mixed model.
- Results indicated similar HRQOL trajectories for both groups, but parents of surgical patients had slightly higher HRQOL, though overall improvement was limited, potentially due to persistent issues in the children.
Objective: Due to variability in reports, the aim of this meta-analysis was to evaluate the incidence and risk factors of post-stroke early seizures (ES) and post-stroke epilepsy (PSE).
Methods: The MEDLINE, EMBASE and Web of Science databases were searched for post-stroke ES/PSE articles published on any date up to November 2020. Post-stroke ES included seizures occurring within 7 days of stroke, and PSE included at least one unprovoked seizure.
Objective: MR-guided laser interstitial thermal therapy (MRgLITT) is associated with lower seizure-free outcome but better safety profile compared to open surgery. However, the predictors of seizure freedom following MRgLITT remain uncertain. This study aimed to use machine learning to predict seizure-free outcome following MRgLITT and to identify important predictors of seizure freedom in children with drug-resistant epilepsy.
View Article and Find Full Text PDFArticle Synopsis
- This study looked at how parents' happiness and stress levels changed over the first two years after their child was evaluated for epilepsy surgery.
- It involved 259 parents and tracked their feelings about depression, anxiety, and family support at different times.
- The research found three groups of parents: those who felt good all the time, those who felt a little better over time, and those who struggled but showed some slight improvement, with better outcomes linked to higher family income and children's health.
Article Synopsis
- The study investigates how pre-operative factors impact health-related quality of life (HRQOL) for children two years after epilepsy surgery, focusing on those with drug-resistant epilepsy.
- It found that a child’s older age at seizure onset and higher HRQOL before surgery significantly predicted better HRQOL outcomes post-surgery.
- The results highlight the importance of assessing and improving a child’s pre-operative quality of life to enhance recovery and overall well-being after epilepsy surgery.
Article Synopsis
- Hippocampal Sclerosis (HS) can occur alongside other brain lesions in children, leading to persistent seizures even after functional hemispherectomy (FH), a surgical procedure to remove one hemisphere of the brain.
- A retrospective study identified three children who developed contralateral HS after undergoing FH for unilateral cortical malformations, all of whom continued to experience seizures post-surgery.
- The research suggests that the underlying mechanisms for contralateral HS in these cases are unclear, but genetic mutations may influence seizure outcomes after epilepsy surgery.
Importance: Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage.
Objective: To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention.
Objectives: The purpose of this longitudinal cohort study was to examine the variables that influence health-related quality of life (HRQOL) after epilepsy surgery in children. We examined whether treatment type (surgical vs medical therapy) and seizure control are related to other variables that have been shown to influence HRQOL, namely depressive symptoms in children with epilepsy or their parents, and the availability of family resources.
Methods: In total, 265 children with drug-resistant epilepsy were recruited from eight epilepsy centers across Canada at the time of their evaluation for candidacy for epilepsy surgery and were assessed at baseline, 6-month, 1-year, and 2-year follow-up.
Background: Evidence is needed to inform thresholds for glycemic management in neonatal encephalopathy (NE). We investigated how severity and duration of dysglycemia relate to brain injury after NE.
Methods: A prospective cohort of 108 neonates ≥36 weeks gestational age with NE were enrolled between August 2014 and November 2019 at the Hospital for Sick Children, in Toronto, Canada.
Objectives: No previous study has examined the management of hospitalized children with orbital cellulitis at both children's and community hospitals across multiple sites in Canada. We describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis.
Patients And Methods: Multicenter cohort study of 1579 children aged 2 months to 18 years with orbital cellulitis infections admitted to 10 hospitals from 2009 to 2018.
Article Synopsis
- A U.S. study evaluated trends in pre-surgical evaluations and epilepsy surgeries from 2001 to 2019, finding a stable or declining rate of surgeries despite an increase in evaluations during this time.
- Among the 1151 children assessed for surgery, there was an upward trend in evaluations from 2001 to 2013, but this trend plateaued from 2014 to 2019, with a significant increase in patients whose seizures could not be localized.
- Overall, while pre-surgical evaluations continued to rise, the actual number of surgeries decreased in the later period, indicating a gap between evaluation and surgical intervention.
Background And Objectives: Seizures are common during neonatal encephalopathy (NE), but the contribution of seizure burden (SB) to outcomes remains controversial. This study aims to examine the relationship between electrographic SB and neurologic outcomes after NE.
Methods: This prospective cohort study recruited newborns ≥36 weeks postmenstrual age around 6 hours of life between August 2014 and November 2019 from a neonatal intensive care unit (NICU).
Importance: Health-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time.
Objective: To assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy.
Aim: To report seizure outcomes in children with GATOR1 gene complex disorders who underwent epilepsy surgery and perform a systematic literature search to study the available evidence.
Methods: The records of children with pathogenic/likely pathogenic variants in GATOR1 gene complex who underwent epilepsy surgery were reviewed. Clinical, radiological, neurophysiological, and histological data were extracted/summarized.
Transorbital penetrating head injury with a favorable outcome: illustrative case.
J Neurosurg Case Lessons
January 2023
Background: Transorbital penetrating head injuries (PHIs) are uncommon but can lead to substantial deficits, depending on intracranial involvement and the neuroanatomical structures affected. Complete recovery after such injuries is rare.
Observations: A 7-year-old boy sustained a PHI when he fell onto a garden spike while climbing a fence.
Objective: Minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been proposed as an alternative to open epilepsy surgery, to address concerns regarding the risk of open surgery. Our primary hypothesis was that seizure freedom at 1 year after MRgLITT is noninferior to open surgery in children with drug-resistant epilepsy (DRE). The secondary hypothesis was that MRgLITT has fewer complications and shorter hospitalization than surgery.
View Article and Find Full Text PDFPharmacogenomics hold the potential to identify variants associated with adverse drug reactions and treatment efficacy of anti-seizure medications. A model-based cost-utility analysis by Gordon and colleagues showed that genetically-guided therapy costs more, yielded higher quality-adjusted life years outcomes, and was considered to be cost-effective compared to usual care. The study provided preliminary evidence on the value of pharmacogenetic testing in patients with drug-resistant epilepsy.
View Article and Find Full Text PDFObjective: There is substantial variability in reported seizure outcome following pediatric epilepsy surgery, and lack of individualized predictive tools that could evaluate the probability of seizure freedom postsurgery. The aim of this study was to develop and validate a supervised machine learning (ML) model for predicting seizure freedom after pediatric epilepsy surgery.
Methods: This is a multicenter retrospective study of children who underwent epilepsy surgery at five pediatric epilepsy centers in North America.