scholarly journals Epilepsy surgery in children under 3 years of age: surgical and developmental outcomes

2021 ◽  
Vol 28 (4) ◽  
pp. 395-403
Author(s):  
Masaki Iwasaki ◽  
Keiya Iijima ◽  
Takahiro Kawashima ◽  
Hisateru Tachimori ◽  
Yutaro Takayama ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Surgical Complication ◽  
Developmental Outcomes ◽  
Clinical Information ◽  
Cyst Formation ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Pediatric Epilepsy Surgery ◽  
Csf Diversion

OBJECTIVE Pediatric epilepsy surgery is known to be effective, but early surgery in infancy is not well characterized. Extensive cortical dysplasia, such as hemimegalencephaly, can cause refractory epilepsy shortly after birth, and early surgical intervention is indicated. However, the complication rate of early pediatric surgery is significant. In this study, the authors assessed the risk-benefit balance of early pediatric epilepsy surgery as relates to developmental outcomes. METHODS This is a retrospective descriptive study of 75 patients who underwent their first curative epilepsy surgery at an age under 3 years at the authors’ institution between 2006 and 2019 and had a minimum 1-year follow-up of seizure and developmental outcomes. Clinical information including surgical complications, seizure outcomes, and developmental quotient (DQ) was collected from medical records. The effects of clinical factors on DQ at 1 year after surgery were evaluated. RESULTS The median age at surgery was 6 months, peaking at between 3 and 4 months. Operative procedures included 27 cases of hemispherotomy, 19 cases of multilobar surgery, and 29 cases of unilobar surgery. Seizure freedom was achieved in 82.7% of patients at 1 year and in 71.0% of patients at a mean follow-up of 62.8 months. The number of antiseizure medications (ASMs) decreased significantly after surgery, and 19 patients (30.6%) had discontinued their ASMs by the last follow-up. Postoperative complications requiring cerebrospinal fluid (CSF) diversion surgery, such as hydrocephalus and cyst formation, were observed in 13 patients (17.3%). The mean DQ values were 74.2 ± 34.3 preoperatively, 60.3 ± 23.3 at 1 year after surgery, and 53.4 ± 25.1 at the last follow-up. Multiple regression analysis revealed that the 1-year postoperative DQ was significantly influenced by preoperative DQ and postoperative seizure freedom but not by the occurrence of any surgical complication requiring CSF diversion surgery. CONCLUSIONS Early pediatric epilepsy surgery has an acceptable risk-benefit balance. Seizure control after surgery is important for postoperative development.

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.

Two-Year Follow-Up of Intelligence After Pediatric Epilepsy Surgery

2005 ◽  
Vol 33 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Marit Korkman ◽  
Marja-Liisa Granström ◽  
Elisa Kantola-Sorsa ◽  
Eija Gaily ◽  
Ritva Paetau ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Epilepsy ◽  
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.

Novel diffusion tractography methodology using Kalman filter prediction to improve preoperative benefit-risk analysis in pediatric epilepsy surgery

2019 ◽  
Vol 24 (3) ◽  
pp. 293-305 ◽  
Author(s):  
Min-Hee Lee ◽  
Nolan B. O’Hara ◽  
Hirotaka Motoi ◽  
Aimee F. Luat ◽  
Csaba Juhász ◽  
...  
Keyword(s):  
Kalman Filter ◽  
Epilepsy Surgery ◽  
Euclidean Distance ◽  
Resection Margin ◽  
Free Probability ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Pediatric Epilepsy Surgery ◽  
Map Analysis ◽  
Benefit And Risk

OBJECTIVEIn this study the authors investigated the clinical reliability of diffusion weighted imaging maximum a posteriori probability (DWI-MAP) analysis with Kalman filter prediction in pediatric epilepsy surgery. This approach can yield a suggested resection margin as a dynamic variable based on preoperative DWI-MAP pathways. The authors sought to determine how well the suggested margin would have maximized occurrence of postoperative seizure freedom (benefit) and minimized occurrence of postoperative neurological deficits (risk).METHODSThe study included 77 pediatric patients with drug-resistant focal epilepsy (age 10.0 ± 4.9 years) who underwent resection of their presumed epileptogenic zone. In preoperative DWI tractography from the resected hemisphere, 9 axonal pathways, Ci=1–9, were identified using DWI-MAP as follows: C1–3supporting face, hand, and leg motor areas; C4connecting Broca’s and Wernicke’s areas; C5–8connecting Broca’s, Wernicke’s, parietal, and premotor areas; and C9connecting the occipital lobe and lateral geniculate nucleus. For each Ci, the resection margin, di, was measured by the minimal Euclidean distance between the voxels of Ciand the resection boundary determined by spatially coregistered postoperative MRI. If Ciwas resected, diwas assumed to be negative (calculated as –1 × average Euclidean distance between every voxel inside the resected Civolume, ri). Kalman filter prediction was then used to estimate an optimal resection margin, d*i, to balance benefit and risk by approximating the relationship between diand ri. Finally, the authors defined the preservation zone of Cithat can balance the probability of benefit and risk by expanding the cortical area of Ciup to d*ion the 3D cortical surface.RESULTSIn the whole group (n = 77), nonresection of the preoperative preservation zone (i.e., actual resection margin d*igreater than the Kalman filter–defined d*i) accurately predicted the absence of postoperative motor (d*1–3: 0.93 at seizure-free probability of 0.80), language (d*4–8: 0.91 at seizure-free probability of 0.81), and visual deficits (d*9: 0.90 at seizure-free probability of 0.75), suggesting that the preservation of preoperative Ciwithin d*isupports a balance between postoperative functional deficit and seizure freedom. The subsequent subgroup analyses found that preservation of preoperative Ci=1–4,9within d*i=1–4,9may provide accurate deficit predictions independent of age and seizure frequency, suggesting that the DWI-based surgical margin can be effective for surgical planning even in young children and across a range of epilepsy severity.CONCLUSIONSIntegrating DWI-MAP analysis with Kalman filter prediction may help guide epilepsy surgery by visualizing the margins of the eloquent white matter pathways to be preserved.

Is postresective intraoperative electrocorticography predictive of seizure outcomes in children?

2012 ◽  
Vol 9 (5) ◽  
pp. 546-551 ◽  
Author(s):  
Carter D. Wray ◽  
Sharon S. McDaniel ◽  
Russell P. Saneto ◽  
Edward J. Novotny ◽  
Jeffrey G. Ojemann
Keyword(s):  
Epilepsy Surgery ◽  
Pediatric Patients ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Low Grade ◽  
Subtle Difference ◽  
Epileptiform Discharges ◽  
Pediatric Epilepsy Surgery

Object Intraoperative electrocorticography (ECoG) is commonly used to guide the extent of resection, especially in lesion-associated intractable epilepsy. Interictal epileptiform discharges on postresective ECoG (post-ECoG) have been predictive of seizure recurrence in some studies, particularly in adults undergoing medial temporal lobectomy, frontal lesionectomy, or low-grade glioma resection. The predictive value of postresective discharges in pediatric epilepsy surgery has not been extensively studied. Methods The authors retrospectively examined the charts of all 52 pediatric patients who had undergone surgery with post-ECoG and had more than 1 year of follow-up between October 1, 2003, and October 1, 2009. Results Of the 52 pediatric patients, 37 patients showed residual discharges at the end of their resection and 73% of these patients were seizure free, whereas 15 patients had no residual discharges and 60% of them were seizure-free, which was not significantly different (p = 0.36, chi-square). Conclusions Electrocorticography-guided surgery was associated with excellent postsurgical outcome. Although this sample size was too small to detect a subtle difference, absence of epileptiform discharges on post-ECoG does not appear to predict seizure freedom in all pediatric patients referred for epilepsy surgery. Future studies with larger study samples would be necessary to confirm this finding and determine whether post-ECoG may be useful in some subsets of pediatric epilepsy surgery candidates.

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.

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