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.

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 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 Depth Electrodes in Pediatric Epilepsy Surgery

2013 ◽  
Vol 40 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Janani Kassiri ◽  
Jeff Pugh ◽  
Sharon Carline ◽  
Laura Jurasek ◽  
Thomas Snyder ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
Surgical Removal ◽  
Seizure Freedom ◽  
Sufficient Information ◽  
Epileptogenic Zone ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Intractable Seizures ◽  
Clinical Scenarios

Abstract:Background:The surgical removal of the epileptogenic zone in medically intractable seizures depends on accurate localization to minimize the neurological sequelae and prevent future seizures. To date, few studies have demonstrated the use of depth electrodes in a pediatric epilepsy population. Here, we report our study of pediatric epilepsy patients at our epilepsy center who were successfully operated for medically intractable seizures following the use of intracranial depth electrodes. In addition, we detail three individuals with distinct clinical scenarios in which depth electrodes were helpful and describe our technical approach to implantation and surgery.Methods:We retrospectively reviewed 18 pediatric epilepsy patients requiring depth electrode studies who presented at the University of Alberta Comprehensive Epilepsy Program between 1999 and 2010 with medically intractable epilepsy. Patients underwent cortical resection following depth electrode placement according to the Comprehensive Epilepsy Program surgical protocols after failure of surface electroencephalogram and magnetic resonance imaging to localize ictal onset zone.Result:The ictal onset zone was successfully identified in all 18 patients. Treatment of all surgical patients resulted in successful seizure freedom (Engel class I) without neurological complications.Conclusion:Intracranial depth electrode use is safe and able to provide sufficient information for the identification of the epileptogenic zone in pediatric epilepsy patients previously not considered for epilepsy surgery.

scholarly journals Resective Epilepsy Surgery for Tuberous Sclerosis in Children

Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 517-524 ◽  
Author(s):  
Aria Fallah ◽  
Shaun D. Rodgers ◽  
Alexander G. Weil ◽  
Sumeet Vadera ◽  
Alireza Mansouri ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Medical Center ◽  
Cleveland Clinic ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract BACKGROUND: There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). OBJECTIVE: We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective epilepsy surgery. METHODS: A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The “event” was defined as seizures after resective epilepsy surgery. RESULTS: Seventy-four patients (41 male) were included. The median age of the patients at the time of surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1- and 2-year follow-up, respectively. On univariate analyses, younger age at seizure onset (hazard ratio [HR]: 2.03, 95% confidence interval [CI]: 1.03-4.00, P = .04), larger size of predominant tuber (HR: 1.03, 95% CI: 0.99-1.06, P = .12), and resection larger than a tuberectomy (HR: 1.86, 95% CI: 0.92-3.74, P = .084) were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy (HR: 2.90, 95% CI: 1.17-7.18, P = .022) was independently associated with a longer duration of seizure freedom. CONCLUSION: In this large consecutive cohort of children with TSC and medically intractable epilepsy, a greater extent of resection (more than just the tuber) is associated with a greater probability of seizure freedom. This suggests that the epileptogenic zone may include the cortex surrounding the presumed offending tuber.

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.

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

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.

scholarly journals A spiking neural network (SNN) for detecting high frequency oscillations (HFOs) in the intraoperative ECoG

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karla Burelo ◽  
Mohammadali Sharifshazileh ◽  
Niklaus Krayenbühl ◽  
Georgia Ramantani ◽  
Giacomo Indiveri ◽  
...  
Keyword(s):  
Neural Network ◽  
Real Time ◽  
Epilepsy Surgery ◽  
High Frequency ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Spiking Neural Network ◽  
High Frequency Oscillations ◽  
Neuromorphic Hardware

AbstractTo achieve seizure freedom, epilepsy surgery requires the complete resection of the epileptogenic brain tissue. In intraoperative electrocorticography (ECoG) recordings, high frequency oscillations (HFOs) generated by epileptogenic tissue can be used to tailor the resection margin. However, automatic detection of HFOs in real-time remains an open challenge. Here we present a spiking neural network (SNN) for automatic HFO detection that is optimally suited for neuromorphic hardware implementation. We trained the SNN to detect HFO signals measured from intraoperative ECoG on-line, using an independently labeled dataset (58 min, 16 recordings). We targeted the detection of HFOs in the fast ripple frequency range (250-500 Hz) and compared the network results with the labeled HFO data. We endowed the SNN with a novel artifact rejection mechanism to suppress sharp transients and demonstrate its effectiveness on the ECoG dataset. The HFO rates (median 6.6 HFO/min in pre-resection recordings) detected by this SNN are comparable to those published in the dataset (Spearman’s $$\rho$$ ρ = 0.81). The postsurgical seizure outcome was “predicted” with 100% (CI [63 100%]) accuracy for all 8 patients. These results provide a further step towards the construction of a real-time portable battery-operated HFO detection system that can be used during epilepsy surgery to guide the resection of the epileptogenic zone.

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