Seizure outcome of pediatric epilepsy surgery

Neurology ◽  
2020 ◽  
Vol 94 (7) ◽  
pp. 311-321 ◽  
Author(s):  
Elysa Widjaja ◽  
Puneet Jain ◽  
Lindsay Demoe ◽  
Astrid Guttmann ◽  
George Tomlinson ◽  
...  
Keyword(s):  
Random Effects ◽  
Medical Therapy ◽  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Incomplete Resection ◽  
Seizure Onset ◽  
Age At Surgery ◽  
Pediatric Epilepsy Surgery

ObjectiveThis systematic review and meta-analyses assessed seizure outcome following pediatric epilepsy surgery.MethodsMEDLINE, EMBASE, and Cochrane were searched for pediatric epilepsy surgery original research from 1990 to 2017. The outcome was seizure freedom at 12 months or longer follow-up. Using random-effects models, the effect sizes for controlled studies, uncontrolled studies on surgery locations (temporal lobe [TL], extratemporal lobe [ETL], or hemispheric surgery), pathologies, nonlesional epilepsy, and incomplete resection were estimated. Meta-regression assessed the relationship between age at surgery, age at seizure onset, and seizure outcome. Random-effects network meta-analysis was conducted for surgery locations.ResultsTwo hundred fifty-eight studies were included. Surgery achieved higher seizure freedom than medical therapy (odds ratio [OR] = 6.49 [95% confidence interval [CI]: 2.87–14.70], p < 0.001). Seizure freedom declined over time after surgery, from 64.8% (95% CI: 51.2%–76.4%; p = 0.034) at 1 year, to 60.3% (95% CI: 52.9%–67.4%; p = 0.007) at 5 years, and to 39.7% (95% CI: 28.4%–52.2%, p = 0.106) at 10 years. Seizure freedom was (1) highest for hemispheric surgery, followed by TL and ETL surgery, and (2) highest for tumor and lower for malformations of cortical development. Seizure freedom was lower for nonlesional than lesional epilepsy (OR = 0.54 [95% CI: 0.34, 0.88], p = 0.013) and incomplete than complete resection (OR = 0.13 [95% CI: 0.08, 0.21], p < 0.001). Age at surgery and age at seizure onset were associated with seizure freedom for mixed pathologies and surgery locations and TL surgery.ConclusionEpilepsy surgery was more effective than medical therapy to control seizures. Understanding seizure outcomes of different surgery locations, pathologies, nonlesional epilepsy, and incomplete resection will assist with presurgical counseling.

scholarly journals Epilepsy surgery failure in children: a quantitative and qualitative analysis

2014 ◽  
Vol 14 (4) ◽  
pp. 386-395 ◽  
Author(s):  
Dario J. Englot ◽  
Seunggu J. Han ◽  
John D. Rolston ◽  
Michael E. Ivan ◽  
Rachel A. Kuperman ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Epilepsy Syndrome ◽  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Mesial Temporal Sclerosis ◽  
Epileptogenic Zone ◽  
Factors Associated ◽  
Resection Cavity ◽  
Pediatric Epilepsy Surgery

Object Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear. Methods The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted. Results Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II–IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%). Conclusions While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.

scholarly journals Pediatric Epilepsy Surgery

2017 ◽  
Vol 32 (5) ◽  
pp. 467-474 ◽  
Author(s):  
Krista J. Qualmann ◽  
Christine G. Spaeth ◽  
Melanie F. Myers ◽  
Paul S. Horn ◽  
Katherine Holland ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
General Population ◽  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Cognitive Disability ◽  
Pediatric Epilepsy Surgery ◽  
Surgery Outcomes

Central nervous system comorbidities have been identified in patients with epilepsy. Several of these comorbidities have been correlated with poor surgery outcomes in patient cohorts. The authors sought to determine if prevalence of comorbidities in pediatric epilepsy surgery patients and their families correlate with long-term seizure outcome in a cross-sectional analysis. Three-generation pedigrees were elicited to compare family history of epilepsy, ADHD, anxiety, autism, bipolar disorder, cognitive disability, depression, migraine, and motor disability to surgery outcomes in 52 patients. Proportions of affected patients and relatives were compared to general population comorbidity rates and the patients’ most recent seizure outcome classification. Patients and families had significantly higher rates of comorbidities than the general population. Poorer long-term seizure outcomes following resective surgery were associated with autism or cognitive disability in patients. Together these data support evidence for a common pathophysiological mechanism between epilepsy and central nervous system comorbidities.

scholarly journals Outcomes of Disconnective Surgery in Intractable Pediatric Hemispheric and Subhemispheric Epilepsy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Santhosh George Thomas ◽  
Ari George Chacko ◽  
Maya Mary Thomas ◽  
K. Srinivasa Babu ◽  
Paul Swamidhas Sudhakar Russell ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Cognitive Skills ◽  
Class I ◽  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Seizure Onset ◽  
Rasmussen’S Encephalitis ◽  
Weber Syndrome ◽  
Surgical Evaluation

Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy.Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel’s classification and cognitive skills by appropriate measures of intelligence that were repeated annually.Results: There were 34 patients in all. Epilepsy was due to Rasmussen’s encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome.Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.

Pediatric Epilepsy Surgery in Focal and Generalized Epilepsy: Current Trends and Recent Advancements

2021 ◽  
Author(s):  
William B. Harris ◽  
H. Westley Phillips ◽  
Aria Fallah ◽  
Gary W. Mathern
Keyword(s):  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Surgical Interventions ◽  
Current Trends ◽  
Pediatric Epilepsy Surgery ◽  
Generalized Epilepsy ◽  
Epileptogenic Foci

AbstractFor a subset of children with medically intractable epilepsy, surgery may provide the best chances of seizure freedom. Whereas the indications for epilepsy surgery are commonly thought to be limited to patients with focal epileptogenic foci, modern imaging and surgical interventions frequently permit successful surgical treatment of generalized epilepsy. Resection continues to be the only potentially curative intervention; however, the advent of various neuromodulation interventions provides an effective palliative strategy for generalized or persistent seizures. Although the risks and benefits vary greatly by type and extent of intervention, the seizure outcomes appear to be uniformly favorable. Advances in both resective and nonresective surgical interventions provide promise for improved seizure freedom, function, and quality of life. This review summarizes the current trends and recent advancements in pediatric epilepsy surgery from diagnostic workup and indications through surgical interventions and postoperative outcomes.

scholarly journals Sociodemographic changes over 25 years of pediatric epilepsy surgery at UCLA

2013 ◽  
Vol 11 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Jason S. Hauptman ◽  
Andrew Dadour ◽  
Taemin Oh ◽  
Christine B. Baca ◽  
Barbara G. Vickrey ◽  
...  
Keyword(s):  
Los Angeles ◽  
Epilepsy Surgery ◽  
Low Income ◽  
Southern California ◽  
Insurance Companies ◽  
Pediatric Epilepsy ◽  
Seizure Onset ◽  
Health Maintenance ◽  
Number Of Patients ◽  
Pediatric Epilepsy Surgery

Object Low income, government insurance, and minority status are associated with delayed treatment for neurosurgery patients. Less is known about the influence of referral location and how socioeconomic factors and referral patterns evolve over time. For pediatric epilepsy surgery patients at the University of California, Los Angeles (UCLA), this study determined how referral location and sociodemographic features have evolved over 25 years. Methods Children undergoing epilepsy neurosurgery at UCLA (453 patients) were classified by location of residence and compared with clinical epilepsy and sociodemographic factors. Results From 1986 to 2010, referrals from Southern California increased (+33%) and referrals from outside of California decreased (−19%). Over the same period, the number of patients with preferred provider organization (PPO) and health maintenance organization (HMO) insurance increased (+148% and +69%, respectively) and indemnity insurance decreased (−96%). Likewise, the number of Hispanics (+117%) and Asians (100%) increased and Caucasians/whites decreased (−24%). The number of insurance companies decreased from 52 carriers per 100 surgical patients in 1986–1990 to 19 per 100 in 2006–2010. Patients living in the Eastern US had a younger age at surgery (−46%), shorter intervals from seizure onset to referral for evaluation (−28%) and from presurgical evaluation to surgery (−61%) compared with patients from Southern California. The interval from seizure onset to evaluation was shorter (−33%) for patients from Los Angeles County compared with those living in non-California Western US states. Conclusions Referral locations evolved over 25 years at UCLA, with more cases coming from local regions; the percentage of minority patients also increased. The interval from seizures onset to surgery was shortest for patients living farthest from UCLA but still within the US. Geographic location and race/ethnicity was not associated with differences in becoming seizure free after epilepsy surgery in children.

Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study

2017 ◽  
Vol 75 ◽  
pp. 151-157 ◽  
Author(s):  
Carmen Barba ◽  
Nicola Specchio ◽  
Renzo Guerrini ◽  
Laura Tassi ◽  
Salvatore De Masi ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Multicenter Study ◽  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Pediatric Epilepsy Surgery

scholarly journals Prediction of Seizure-onset Laterality by Using Wada Memory Asymmetries in Pediatric Epilepsy Surgery Candidates

Epilepsia ◽  
2002 ◽  
Vol 43 (9) ◽  
pp. 1049-1055 ◽  
Author(s):  
Gregory P. Lee ◽  
Yong D. Park ◽  
Ann Hempel ◽  
Michael Westerveld ◽  
David W. Loring
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
Seizure Onset ◽  
Pediatric Epilepsy Surgery

Cognitive Development in Pediatric Epilepsy Surgery

2017 ◽  
Vol 49 (02) ◽  
pp. 093-103 ◽  
Author(s):  
Gitta Reuner ◽  
Georgia Ramantani
Keyword(s):  
Cognitive Development ◽  
Epilepsy Surgery ◽  
Verbal Learning ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Effective Treatment Option ◽  
Multicenter Studies ◽  
Assessment Protocol ◽  
Pediatric Epilepsy Surgery ◽  
Developmental Impairment

AbstractEpilepsy surgery is a very effective treatment option for children and adolescents with drug-resistant structural epilepsy, resulting in seizure freedom in the majority of cases. Beyond seizure freedom, the postsurgical stabilization or even improvement of cognitive development constitutes a fundamental objective. This study aims to address key features of cognitive development in the context of pediatric epilepsy surgery. Many surgical candidates present with severe developmental delay and cognitive deficits prior to surgery. Recent studies support that global cognitive development remains stable after surgery. Individual developmental trajectories are determined by the degree of presurgical developmental impairment, age at surgery, seizure freedom, antiepileptic drug tapering, and other case-specific factors. Compared with adults, children may better compensate for temporary postsurgical deficits in circumscribed cognitive functions such as memory. Particularly for left-sided temporal resections, children present a clear advantage in terms of postsurgical recovery with regard to verbal learning compared with adults. In the case of severe presurgical developmental impairment, minimal postsurgical improvements are often not measurable, although they are evident to patients' families and have a large impact on their quality of life. Multicenter studies with a standardized assessment protocol and longer follow-up intervals are urgently called for to provide deeper insights into the cognitive development after epilepsy surgery, to analyze the interaction between different predictors, and to facilitate the selection of appropriate candidates as well as the counseling of families.

Pediatric Epilepsy Surgery

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. 985-993 ◽  
Author(s):  
Jason S. Hauptman ◽  
Kayvon Pedram ◽  
Christia Angela Sison ◽  
Raman Sankar ◽  
Noriko Salamon ◽  
...  
Keyword(s):  
Free Group ◽  
Epilepsy Surgery ◽  
Hippocampal Sclerosis ◽  
Outcome Data ◽  
Pediatric Epilepsy ◽  
Seizure Outcome ◽  
Seizure Recurrence ◽  
Single Institution ◽  
Pediatric Epilepsy Surgery

Abstract BACKGROUND: It is unclear whether long-term seizure outcomes in children are similar to those in adult epilepsy surgery patients. OBJECTIVE: To determine 5-year outcomes and antiepilepsy drug (AED) use in pediatric epilepsy surgery patients from a single institution. METHODS: The cohort consisted of children younger than 18 years of age whose 5-year outcome data would have been available by 2010. Comparisons were made between patients with and without 5-year data (n = 338), patients with 5-year data for seizure outcome (n = 257), and seizure-free patients on and off AEDs (n = 137). RESULTS: Five-year data were available from 76% of patients. More seizure-free patients with focal resections for hippocampal sclerosis and tumors lacked 5-year data compared with other cases. Of those with 5-year data, 53% were continuously seizure free, 18% had late seizure recurrence, 3% became seizure free after initial failure, and 25% were never seizure free. Patients were more likely to be continuously seizure free if their surgery was performed during the period 2001 to 2005 (68%) compared with surgery performed from 1996 to 2000 (61%), 1991 to 1995 (36%), and 1986 to 1990 (46%). More patients had 1 or fewer seizures per month in the late seizure recurrence (47%) compared with the not seizure-free group (20%). Four late deaths occurred in the not seizure-free group compared with 1 in the seizure-free group. Of patients who were continuously seizure free, 55% were not taking AEDs, and more cortical dysplasia patients (74%) had stopped taking AEDs compared with hemimegalencephaly patients (18%). CONCLUSION: In children, 5-year outcomes improved over 20 years of clinical experience. Our results are similar to those of adult epilepsy surgery patients despite mostly extratemporal and hemispheric operations for diverse developmental etiologies.

Sign in / Sign up

Export Citation Format

Share Document