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Lobar and multilobar resections for medically intractable pediatric epilepsy
J W Leiphart1, W J Peacock, G W Mathern
1Division of Neurosurgery, Mental Retardation Research Center and Brain Research Institute, University of California, Los Angeles, CA, USA.
Insights
Pediatric epilepsy surgery outcomes depend on lesion location and pathology. Temporal lobe resections and mass lesions offered the best seizure control, but all surgeries improved seizure frequency.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Pediatric epilepsy surgery differs from adult epilepsy surgery, with a higher prevalence of extratemporal lesions and cortical dysplasia as the primary pathology.
- Understanding factors influencing surgical outcomes in pediatric epilepsy is crucial for improving patient management.
Purpose of the Study:
- To investigate the relationship between the lobe of resection, tissue pathology, and seizure outcomes in pediatric epilepsy surgery patients.
- To identify predictors of successful surgical intervention for epilepsy in children.
Main Methods:
- Retrospective analysis of 111 pediatric epilepsy patients who underwent lobar or multilobar resections between 1986 and 2000.
- Comparison of pre- and postoperative seizure frequencies based on the lobe of resection (temporal vs. extratemporal) and tissue pathology (mass lesions, cortical dysplasia, etc.).
Main Results:
- Temporal lobe resections were associated with significantly lower pre- and postoperative seizure frequencies compared to extratemporal single lobe resections.
- Single lobe resections generally yielded better seizure control than multilobar resections, particularly in temporal lobe cases.
- Patients with mass lesions demonstrated the best postoperative seizure control, followed by those with cortical dysplasia.
Conclusions:
- Seizure outcomes following pediatric epilepsy surgery are influenced by both the location of the resected lesion and its underlying pathology.
- Temporal lobe epilepsy surgery, especially for mass lesions, appears to offer the most favorable seizure control.
- Regardless of location or pathology, epilepsy surgery leads to significant improvements in seizure frequency for pediatric patients.
Abstract:
Pediatric epilepsy surgery patients are different than adult epilepsy surgery patients by having a higher proportion of extratemporal than temporal lobe lesions, and by having cortical dysplasia as the most frequent pathology. We analyzed 111 pediatric epilepsy patients who received lobar or multilobar resections at the University of California, Los Angeles, between the years 1986 and 2000 to determine if there were differences in seizure outcome by lobe of resection and tissue pathology. Results showed that temporal lobe resection patients had lower pre- and postoperative seizure frequencies compared with extratemporal single lobe resection patients (p < 0.05). Furthermore, single lobe resection patients from any brain region had lower pre- and postoperative seizure frequencies compared with multilobar resection patients (p < 0.05), an effect which was due to the better seizure outcomes in temporal lobe resection cases. Patients with mass lesions had the best postoperative seizure control, followed by cortical dysplasia patients and other pathologies (p < 0.05). In all patient groups, there was a significant reduction in pre- to postoperative seizure frequencies (p < 0.0001). These results indicate that postsurgery seizure outcomes in pediatric epilepsy surgery patients vary by lesion location and pathology, with the best outcomes in temporal lobe patients with mass lesions. However, surgical resections of epileptogenic lesions, regardless of lobe, were associated with significant postoperative improvements in seizure frequency.