Predictors of outcome in pediatric epilepsy surgery
J M Paolicchi1, P Jayakar, P Dean
1Children's Hospital, Ohio State University, Columbus, USA.
Insights
Complete resection of the seizure focus is key for good outcomes in pediatric epilepsy surgery. Other factors like lesion status or pathology did not significantly impact seizure control after focal resections.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Surgical Neurology
Background:
- Medically intractable partial epilepsy in children often necessitates surgical intervention.
- Focal resections aim to remove the epileptogenic zone to achieve seizure freedom.
- Predicting surgical outcomes in pediatric epilepsy remains a critical clinical challenge.
Purpose of the Study:
- To identify pre- and perioperative variables correlating with outcomes in pediatric patients undergoing focal epilepsy resections.
- To evaluate the impact of specific factors on seizure control post-surgery.
Main Methods:
- Retrospective analysis of 75 pediatric patients (<12 years) with at least 1 year follow-up post-focal resection.
- Variables analyzed included age, epilepsy duration, cognitive status, seizure origin, lesion presence, pathology, and completeness of resection.
- Outcome was defined by postoperative seizure frequency (Engel classification).
Main Results:
- Overall, 77% of patients achieved good outcomes (Engel class 1 or 2), with 59% seizure-free.
- Completeness of resection was the sole significant predictor of good outcome (p < 0.001).
- Patients with complete resection of the epileptogenic zone had a 92% good outcome rate versus 50% for incomplete resections. Multilobar resections showed poorer outcomes.
Conclusions:
- Complete resection of the epileptogenic zone is the primary determinant of successful surgical outcomes in pediatric focal epilepsy.
- Factors other than complete resection, such as lesion characteristics or histopathology, did not significantly influence seizure prognosis.
- Surgical candidacy should primarily focus on the potential for complete resection of the identified seizure focus.
Objective:
To determine the correlation between pre- and perioperative variables on the outcome of children undergoing focal resections for medically intractable partial epilepsy.
Methods:
Retrospective analysis of pre- and perioperative variables in a cohort of 75 patients younger than 12 years of age who underwent excisional surgery and had at least 1 year of follow-up. Outcome, measured by postoperative seizure frequency, was analyzed as a function of age at seizure onset, duration of epilepsy, presence of cognitive impairment, lobe of seizure origin, presence of a lesion, histopathology, and completeness of resection. Completeness of resection was defined on the basis of excising both the entire structural lesion if present and the region revealing prominent interictal and ictal abnormalities on intracranial EEG.
Results:
Seventy-seven percent of patients had good outcomes (class 1 or 2), and 59% were seizure-free. Lesional status, site of resection, and pathologic diagnoses were not significant predictors of outcome except for in multilobar resection, for which overall outcome was relatively poor (44% class 3 or 4; 22% seizure-free). Completeness of resection was the only significant predictor of good outcome (p < 0.001), with 92% of patients who underwent complete resection of the epileptogenic zone achieving good outcome compared with 50% of patients who had incomplete resections.
Conclusion:
In this series of pediatric patients, complete resection of the lesion and the electrographically abnormal region was the main determinant of outcome after focal resections. Except for multilobar resections, other factors examined in this study did not significantly influence postoperative seizure prognosis and should not influence candidate selection for the surgical process.
