Selection of children with drug resistant epilepsy who are candidates for epilepsy surgery: pre and post-operative evaluation

Abstract Objective To select patients with drug resistant epilepsy following up in Pediatrics Neurology Outpatient Clinic of Children's Hospital, Ain Shams University who are candidates for epilepsy surgery and to detect outcome of epilepsy surgery in such children as regards seizures control. Methods This prospective study was conducted over a period of 36 months and comprises of 3 stages. Stage 1 includes selection of candidates for epilepsy surgery and preoperative evaluation. Evaluation included clinical assessment, video EEG, MRI epilepsy protocol. Stage 2 include surgery phase where decision of surgery was made by a multidisciplinary team. Stage 3 includes post-operative evaluation as regards Seizures frequency, Seizures Severity using Chalfont score, Engel Epilepsy Surgery Outcome Scale and the International League Against Epilepsy (ILAE) outcome classification. Data was tabulated and analyzed with SSPS package for windows. Results 17 patients underwent epilepsy surgery. Results revealed significant decrease in seizures frequency and severity at 6 and 12 months after surgery. As regards Engel Epilepsy Surgery Outcome Scale 11 (64.7%) patients were class I at 12 months. As regards the ILAE outcome classification 10 (58.8%) patients are class 1 at 12 months. Conclusions epilepsy surgery can be a hope for patients with drug resistant epilepsy who are well selected and evaluated preoperatively. New studies on larger number and for longer duration are recommended.

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Surgical Resection Can Be Successful in a Large Fraction of Patients With Drug-Resistant Epilepsy Associated With Multiple Cerebral Cavernous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000210 ◽

2013 ◽

Vol 74 (2) ◽

pp. 147-153 ◽

Cited By ~ 8

Author(s):

Christian von der Brelie ◽

Marec von Lehe ◽

Anna Raabe ◽

Pitt Niehusmann ◽

Horst Urbach ◽

...

Keyword(s):

Surgical Treatment ◽

Epilepsy Surgery ◽

Large Fraction ◽

Cerebral Cavernous Malformations ◽

Drug Resistant ◽

Cavernous Malformations ◽

Predictive Parameters ◽

Class 1 ◽

Drug Resistant Epilepsy

Abstract BACKGROUND: Multiple cerebral cavernous malformations (mCCMs) are known as potentially epileptogenic lesions. Treatment might be multimodal. Management of patients with mCCMs and epilepsy is challenging. OBJECTIVE: To evaluate (1) algorhythmic therapeutic sequences in patients with epilepsy associated to mCCMs, (2) whether there are predictive parameters to anticipate the development of drug-resistant epilepsy, and (3) seizure after epilepsy surgery compared to conservatively-treated drug-resistant patients. METHODS: All inpatients and outpatients with epilepsy associated to mCCMs from 1990 to 2010 and follow-up >12 months available were retrospectively analyzed. RESULTS: Twenty-three patients matched inclusion criteria. Epilepsy became drug-resistant in 18/23 (78%) patients. No predictors were found for development of drug-resistant epilepsy. Median follow-up for both groups was 7.8 years. Nine patients did not qualify for surgical therapy and were treated conservatively. One patient of this cohort (11%) was seizure-free (International League Against Epilepsy [ILAE] class 1). Surgical treatment was performed in 9 patients; 7/9 (78%) of these patients were seizure-free (ILAE class 1) after epilepsy surgery for at least 12 months compared with 1/9 patients in the non-operated group. In 7/9 cases (78%) the largest CCM was resected. In 8/9 (89%) not all CCMs were resected. CONCLUSION: After initial diagnosis of epilepsy associated to mCCMs, a primary conservative approach is reasonable. Surgical treatment can be successful in a large fraction of cases with drug-resistant epilepsy where an epileptogenic lesion is identified. Cases where surgery is not undertaken are likely to remain intractable.

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Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy

Neurosurgical FOCUS ◽

10.3171/2018.7.focus18220 ◽

2018 ◽

Vol 45 (3) ◽

pp. E3 ◽

Cited By ~ 6

Author(s):

Jonathan Pindrik ◽

Nguyen Hoang ◽

Luke Smith ◽

Mark Halverson ◽

Mary Wojnaroski ◽

...

Keyword(s):

Literature Review ◽

Surgical Management ◽

Epilepsy Surgery ◽

Preoperative Evaluation ◽

Case Series ◽

Developmental Outcomes ◽

Drug Resistant ◽

Infants And Toddlers ◽

Study Team ◽

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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Implementing an epilepsy surgery center. Initial experience at a university hospital in Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170125 ◽

2017 ◽

Vol 75 (10) ◽

pp. 722-726 ◽

Cited By ~ 1

Author(s):

Gabriel Pereira Escudeiro ◽

Rafael Teixeira Magalhães Leal ◽

Heros Henrique Melo de Almeida ◽

Marcus Andre Acioly ◽

José Alberto Landeiro ◽

...

Keyword(s):

Epilepsy Surgery ◽

University Hospital ◽

Drug Resistant ◽

Initial Experience ◽

Treatment Results ◽

Epilepsy Treatment ◽

Class 1 ◽

First Results ◽

Surgery Center ◽

International League

ABSTRACT Epilepsy is a serious neurological condition, often without a full and effective treatment. In some cases, surgery is beneficial, despite being underused. Our aim herein is to describe the implementation of an epilepsy surgery center in a federal university hospital, sharing the initial experience gained, as well as describing the main challenges and first results. Methods: Experience report of an epilepsy surgery center implementation. Retrospective review of 13 drug-resistant patients who underwent surgical treatment. Results: Thirteen patients underwent surgical epilepsy treatment, five patients categorized as the International League Against Epilepsy class 1, two in class 2, three in class 3, zero in class 4, and two in class 5; with a 30.76% complication rate. Conclusion: Despite the challenges, it was possible to implement an epilepsy surgery center with favorable results and acceptable incidence of complications, which were not higher than the incidences found in more experienced centers.

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Seizure frequency and social outcome in drug resistant epilepsy patients who do not undergo epilepsy surgery

Seizure ◽

10.1016/j.seizure.2011.04.010 ◽

2011 ◽

Vol 20 (7) ◽

pp. 580-582 ◽

Cited By ~ 8

Author(s):

Mar Carreño ◽

Juan Luis Becerra ◽

Joaquín Castillo ◽

Iratxe Maestro ◽

Antonio Donaire ◽

...

Keyword(s):

Seizure Frequency ◽

Epilepsy Surgery ◽

Drug Resistant ◽

Social Outcome ◽

Drug Resistant Epilepsy

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Fifteen-minute consultation: When medicines don’t work—the child with poorly controlled seizures

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2018-316035 ◽

2018 ◽

Vol 104 (3) ◽

pp. 135-140

Author(s):

Pooja Harijan ◽

Arnab Kumar Seal ◽

Manish Prasad ◽

William P Whitehouse

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Drug Resistant ◽

Algorithmic Approach ◽

Life Management ◽

Drug Resistant Epilepsy

Drug-resistant epilepsy (DRE) occurs in 20%–30% of children with epilepsy with significant impact on their quality of life. Management of this group of children has greatly improved in the recent years with streamlining of epilepsy surgery services and associated quaternary multimodal evaluation. This article provides a review of DRE in children and management based on recent evidence and published opinion. We have also presented an algorithmic approach to the child with possible DRE.

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Does epilepsy surgery lower the mortality of drug-resistant epilepsy?

Epilepsy Research ◽

10.1016/j.eplepsyres.2003.10.001 ◽

2003 ◽

Vol 56 (2-3) ◽

pp. 105-120 ◽

Cited By ~ 36

Author(s):

P Ryvlin ◽

P Kahane

Keyword(s):

Epilepsy Surgery ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions

Journal of Epileptology ◽

10.1515/joepi-2015-0025 ◽

2015 ◽

Vol 23 (1) ◽

pp. 39-44

Author(s):

Alexandra Rohracher ◽

Judith Dobesberger ◽

Claudia A. Granbichler ◽

Julia Höfler ◽

Giorgi Kuchukhidze ◽

...

Keyword(s):

Drug Resistance ◽

Epilepsy Surgery ◽

Treatment Process ◽

Drug Resistant ◽

Course Of Disease ◽

Clinical Applicability ◽

Specialized Center ◽

Drug Resistant Epilepsy ◽

Definition Of ◽

Mean Time

SUMMARY Background. Early identification of potential epilepsy surgery candidates is essential to the treatment process. Aim. To evaluate the clinical applicability of the ILAE definition of drug resistant epilepsy and its potential in identifying surgical candidates earlier compared to three established “older” definitions of drug resistant epilepsy. Material and Methods. Retrospective analysis of 174 patients who underwent epilepsy surgery between 1998 and 2009. Clinical factors and course of disease were extracted from patients' charts. Drug resistant epilepsy was classified according to four definitions and the time until fulfillment of criteria compared. Results. Mean time to fulfillment of criteria of drug resistant epilepsy ranged from 11.8 (standard deviation (SD) 9.8) to 15.6 years (SD 11.3). Time to drug resistance was significantly longer applying the only definition, requiring failure of three antiepileptic drugs (AEDs) (Canada definition), whereas time to fulfillment of all other definitions did not differ. Fifty percent of all patients experienced a seizure free period of ≥1 year prior to being classified as drug resistant, 13% entered another 1-year remission after fulfilling any criteria for drug resistance. Conclusion. We conclude that the ILAE definition identifies drug resistant epilepsy, with similar latency like two of three formerly used definitions. It is an easy applicable tool to minimize the delay of referral to a specialized center. Intermittent remissions delay assessment of drug resistance for all definitions and 13% of patients enter a remission despite established drug resistance.

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Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 1: invasive monitoring using the parasagittal transinsular apex depth electrode

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.4.peds15636 ◽

2016 ◽

Vol 18 (5) ◽

pp. 511-522 ◽

Cited By ~ 13

Author(s):

Alexander G. Weil ◽

Aria Fallah ◽

Evan C. Lewis ◽

Sanjiv Bhatia

Keyword(s):

Epilepsy Surgery ◽

Electrode Placement ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Depth Electrodes ◽

Depth Electrode ◽

Age At Surgery ◽

Feasible Alternative ◽

The Mean ◽

Drug Resistant Epilepsy

OBJECTIVE Insular lobe epilepsy (ILE) is an under-recognized cause of extratemporal epilepsy and explains some epilepsy surgery failures in children with drug-resistant epilepsy. The diagnosis of ILE usually requires invasive investigation with insular sampling; however, the location of the insula below the opercula and the dense middle cerebral artery vasculature renders its sampling challenging. Several techniques have been described, ranging from open direct placement of orthogonal subpial depth and strip electrodes through a craniotomy to frame-based stereotactic placement of orthogonal or oblique electrodes using stereo-electroencephalography principles. The authors describe an alternative method for sampling the insula, which involves placing insular depth electrodes along the long axis of the insula through the insular apex following dissection of the sylvian fissure in conjunction with subdural electrodes over the lateral hemispheric/opercular region. The authors report the feasibility, advantages, disadvantages, and role of this approach in investigating pediatric insular-opercular refractory epilepsy. METHODS The authors performed a retrospective analysis of all children (< 18 years old) who underwent invasive intracranial studies involving the insula between 2002 and 2015. RESULTS Eleven patients were included in the study (5 boys). The mean age at surgery was 7.6 years (range 0.5–16 years). All patients had drug-resistant epilepsy as defined by the International League Against Epilepsy and underwent comprehensive noninvasive epilepsy surgery workup. Intracranial monitoring was performed in all patients using 1 parasagittal insular electrode (1 patient had 2 electrodes) in addition to subdural grids and strips tailored to the suspected epileptogenic zone. In 10 patients, extraoperative monitoring was used; in 1 patient, intraoperative electrocorticography was used alone without extraoperative monitoring. The mean number of insular contacts was 6.8 (range 4–8), and the mean number of fronto-parieto-temporal hemispheric contacts was 61.7 (range 40–92). There were no complications related to placement of these depth electrodes. All 11 patients underwent subsequent resective surgery involving the insula. CONCLUSIONS Parasagittal transinsular apex depth electrode placement is a feasible alternative to orthogonally placed open or oblique-placed stereotactic methodologies. This method is safe and best suited for suspected unilateral cases with a possible extensive insular-opercular epileptogenic zone.

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