Postoperative seizure and developmental outcomes of children with hemimegalencephaly and drug-resistant epilepsy

OBJECTIVEDespite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE.METHODSThe study team conducted a systematic literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, targeting studies that investigated children < 3 years of age undergoing surgical treatment of DRE. Using the PubMed database, investigators selected peer-reviewed articles that reported seizure outcomes with or without developmental outcomes and/or perioperative complications. Studies were eliminated based on the following exclusion criteria: sample size < 5 patients; and inclusion of patients > 3 years of age, when demographic and outcomes data could not be separated from the cohort of patients < 3 years of age.RESULTSThe study team identified 20 studies published between January 1990 and May 2017 that satisfied eligibility criteria. All selected studies represented retrospective reviews, observational studies, and uncontrolled case series. The compiled group of studies incorporated 465 patients who underwent resective or disconnective surgery (18 studies, 444 patients) or vagus nerve stimulator insertion (2 studies, 21 patients). Patient age at surgery ranged between 28 days and 36 months, with a mean of 16.8 months (1.4 years).DISCUSSIONThe study team provided a detailed summary of the literature review, focusing on the etiologies, preoperative evaluation, surgical treatments, seizure and developmental outcomes, and potential for functional recovery of infants and toddlers with DRE. Additionally, the authors discussed special considerations in this vulnerable age group from the perspective of multiple disciplines.CONCLUSIONSWhile presenting notable challenges, pediatric epilepsy surgery within infants and toddlers (children < 3 years of age) offers significant opportunities for improved seizure frequency, neuro-cognitive development, and quality of life. Successful evaluation and treatment of young children with DRE requires special consideration of multiple aspects related to neurological and physiological immaturity and surgical morbidity.

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Predictors of seizure outcome following resective surgery for drug-resistant epilepsy associated with focal gliosis

Journal of Neurosurgery ◽

10.3171/2018.3.jns172949 ◽

2019 ◽

Vol 130 (6) ◽

pp. 2071-2079

Author(s):

Gopal K. Dash ◽

Chaturbhuj Rathore ◽

Malcolm K. Jeyaraj ◽

Pandurang Wattamwar ◽

Sankara P. Sarma ◽

...

Keyword(s):

Postoperative Outcome ◽

Posterior Region ◽

Seizure Outcome ◽

Drug Resistant ◽

Resective Surgery ◽

Common Etiology ◽

Neurological Infections ◽

Drug Resistant Epilepsy ◽

Postoperative Seizure

OBJECTIVEThe authors studied the clinical characteristics and postoperative outcomes of drug-resistant epilepsy associated with focal gliosis.METHODSFrom their epilepsy surgery database, the authors selected the patients with drug-resistant epilepsy and MRI-defined focal gliosis who underwent focal resective surgery. All patients underwent standard presurgical evaluation. Intracranial electroencephalography (EEG) was performed in patients with discordant presurgical data, ill-defined lesions, and lesions close to eloquent regions. Completeness of resection was defined on the basis of extraoperative and intraoperative electrocorticography studies. Favorable postoperative outcome was defined as Engel class I outcome during the last 2 years of follow-up.RESULTSSixty-six patients fulfilled inclusion criteria. An initial precipitating injury was present in 38 (57.6%) patients, mainly in the form of perinatal injury (n = 10), trauma (n = 10), and meningoencephalitis (n = 8). Gliosis involved a single lobe in 38 (57.6%) patients and 2 adjacent lobes in 14 (21.2%) patients; the remaining 14 (21.2%) patients had multilobar gliosis. In patients with unilobar or bilobar gliosis, the posterior region of the head was involved in 34 (65%) patients and the frontal lobes in 12 (23%) patients. During a median follow-up of 4 years (range 2–9 years), 41 (62.1%) patients had favorable outcome. On multivariate analysis, the presence of a well-defined aura (p = 0.019), electrocorticographically defined completeness of resection (p = 0.024), and normal postoperative EEG findings at 1 year (p = 0.003) were predictive of favorable postoperative seizure outcome.CONCLUSIONSFocal gliosis is a common etiology for drug-resistant extratemporal epilepsy in developing countries and is most often located in the posterior region of the head. The majority of these patients have perinatal injuries or neurological infections as initial precipitating injuries. Patients with focal gliosis have good postoperative seizure outcomes after well-planned resective surgery.

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Postoperative seizure outcome and timing interval to start antiepileptic drug withdrawal: A retrospective observational study of non-neoplastic drug resistant epilepsy

Scientific Reports ◽

10.1038/s41598-018-31092-3 ◽

2018 ◽

Vol 8 (1) ◽

Author(s):

Le Zhang ◽

Xin-Yue Jiang ◽

Dong Zhou ◽

Heng Zhang ◽

Shi-Min Bao ◽

...

Keyword(s):

Observational Study ◽

Antiepileptic Drug ◽

Drug Withdrawal ◽

Retrospective Observational Study ◽

Seizure Outcome ◽

Drug Resistant ◽

Timing Interval ◽

Antiepileptic Drug Withdrawal ◽

Drug Resistant Epilepsy ◽

Postoperative Seizure

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Corpus callosotomy for treatment of drug-resistant epilepsy: a review of 16 pediatric cases in northern Vietnam

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.12.peds19638 ◽

2020 ◽

Vol 25 (6) ◽

pp. 582-587

Author(s):

Nguyen Duc Lien ◽

Dang Anh Tuan ◽

Cao Vu Hung ◽

Jacob R. Lepard ◽

Brandon G. Rocque

Keyword(s):

Neurological Deficits ◽

Seizure Outcome ◽

Drug Resistant ◽

Imaging Findings ◽

Corpus Callosotomy ◽

Resource Limited Settings ◽

Resource Limited ◽

Drug Resistant Epilepsy ◽

Postoperative Seizure

OBJECTIVEThe aim of this study was to evaluate postoperative seizure outcome in children with drug-resistant epilepsy not eligible for focal resection who underwent corpus callosotomy.METHODSThe study included 16 patients undergoing corpus callosotomy between September 2015 and May 2018. Seizure semiology and frequency, psychomotor status, and video electroencephalography and imaging findings were evaluated for all patients.RESULTSOf the 16 patients who underwent callosotomy during the study period, 11 underwent complete callosotomy and 5 underwent anterior only. Seizure improvement greater than 75% was achieved in 37.5% of patients, and another 50% of patients had seizure improvement of 50%–75%. No sustained neurological deficits were observed in these patients. There were no significant complications. Duration of postoperative follow-up ranged from 12 to 44 months.CONCLUSIONSCorpus callosotomy is an effective treatment for selected patients with drug-resistant epilepsy not eligible for focal resection in resource-limited settings. Fostering and developing international epilepsy surgery centers should remain a high priority for the neurosurgical community at large.

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