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Surgical management of intractable epilepsy in children with hemophilia
1Departments of Surgery, Children's Medical Center, Medical College of Georgia, Augusta 30912, USA. dyeh@mail.mcg.edu
Insights
Surgical treatment for medically refractory epilepsy in children with hemophilia is safe and effective. Hemispherotomy, with continuous factor replacement, led to significant seizure reduction or freedom in two pediatric cases.
Area of Science:
- Pediatric Neurology
- Hematology
- Neurosurgery
Background:
- Intracranial hemorrhage (ICH) is a known complication in hemophilia patients, potentially leading to epilepsy.
- Limited data exists on the surgical management of epilepsy in children with hemophilia.
Observation:
- Two children with hemophilia developed medically refractory epilepsy.
- Both underwent hemispherotomy with continuous factor replacement for perioperative management.
Findings:
- Both patients tolerated the surgery well, without complications or worsened neurological deficits.
- One child achieved complete seizure freedom, while the other experienced a 90% reduction in seizure frequency.
Implications:
- Hemispherotomy is a safe and effective surgical option for intractable epilepsy in pediatric hemophilia patients.
- This approach can significantly improve seizure control and quality of life in this vulnerable population.
Abstract:
Intracranial hemorrhage occurs in 2-8% of patients with hemophilia and can result in neurologic sequelae including seizure disorders. There is a paucity of data concerning the surgical treatment of epilepsy in children with hemophilia. We review our experience with 2 children who developed medically refractory seizure disorders. Both children underwent hemispherotomy, at 18 months (case 1) and 13 years of age (case 2), respectively. Perioperative management included continuous factor replacement. Both children tolerated surgical intervention without complications or increased neurologic deficit. Case 2 showed a 90% reduction in seizure frequency, and case 1 is seizure free. Surgical management of intractable epilepsy in children with hemophilia is safe and effective.
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