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 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.

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 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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