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Surgery of epilepsy associated with focal lesions in childhood
M Bourgeois1, C Sainte-Rose, A Lellouch-Tubiana
1Unité de Neurologie Pédiatrique et Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Early epilepsy surgery in children can lead to better outcomes. Minimally invasive procedures with complete lesion removal and short preoperative seizure duration improve success rates for medically refractory epilepsy.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Epilepsy surgery in children is an emerging field.
- Key challenges include patient selection, surgical approach, and optimal timing.
- This study addresses these critical issues in pediatric epilepsy management.
Purpose of the Study:
- To identify factors influencing the success of epilepsy surgery in children.
- To elucidate the impact of surgical timing and technique on outcomes.
- To analyze the effects of epilepsy surgery on cognitive and behavioral functions.
Main Methods:
- Retrospective analysis of 200 children (aged 1-15) who underwent epilepsy surgery.
- Focus on medically refractory epilepsy cases with focal cortical lesions.
- Surgical resection of lesions, with follow-up averaging 5.8 years.
Main Results:
- 71.3% achieved seizure freedom (Engel Class 1a), 82% were Class I.
- Successful surgery correlated with minimally traumatic procedures, complete lesion resection, and short preoperative seizure duration.
- Post-surgery, behavioral disorders improved in 31% and cognitive function in 25%.
Conclusions:
- Patient selection and surgical timing are crucial for optimal outcomes.
- Early surgical intervention is recommended to support healthy brain development.
- Longer epilepsy duration negatively impacts cognitive function; seizure frequency affects behavior.
Object:
Surgery in children with epilepsy is a new, evolving field. The important practical issues have been to define strategies for choosing the most suitable candidates and the type and optimal timing of epilepsy surgery. This study was undertaken to elucidate these points.
Methods:
To identify the factors that correlated with outcome, the authors analyzed a series of 200 children (aged 1-15 years (mean 8.7 years) who underwent surgery between 1981 and 1996 at the Hôpital Necker-Enfants Malades. In 171 cases (85.5%) the epilepsy was medically refractory and was associated with focal cortical lesions. Surgery consisted of resection of the lesion without specifically attempting to identify and remove the "epileptogenic area. "In the group of children whose seizures were medically refractory, the mean follow-up period was 5.8 years. According to Engel's classification, 71.3% of these children became seizure free (Class 1a,) whereas 82% were in Class I. A multivariate statistical analysis revealed that among all the factors studied, the success of surgery in a patient in whom there was a good clinical/electroencephalogram/imaging correlation depended on the patient's having undergone a minimally traumatic operation, a complete resection of the lesion, and a short preoperative seizure duration. After the surgical control of epilepsy, behavior disorders were more improved (31% of all patients) than cognitive function (25%). The patient age at onset, duration and frequency of seizures, intractability of the disease to therapy, and seizure characteristics were correlated with cognitive, behavioral, and academic performance pre- and postoperatively. Multivariate statistical analysis revealed that cognitive dysfunction correlated highly with the duration of epilepsy prior to surgery, whereas behavioral disorders correlated more with seizure frequency.
Conclusions:
These data must be taken into account when selecting patients for surgical treatment and when deciding the timing of surgery. Early surgical intervention allows for optimum brain development.