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The early identification of candidates for epilepsy surgery
1Division of Neurology, The Children's Hospital of Philadelphia, 6th Floor, Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA 19014, USA. dlugos@email.chop.edu
Abstract:
The effectiveness of resective surgery for the treatment of carefully selected patients with medically intractable, localization-related epilepsy is clear. Seizure-free rates following temporal lobectomy are consistently 65% to 70% in adults and 68% to 78% in children. Extratemporal resections less commonly lead to a seizure-free outcome, although one recent childhood series reported a seizure-free rate of 62% following extratemporal epilepsy surgery. With both temporal and extratemporal resections, additional patients have a reduction in seizures following surgery but are not completely seizure free. The identification of favorable surgical candidates has been the subject of extensive research, and many investigators have examined predictors of outcome following epilepsy surgery. However, the early identification of the potential epilepsy surgery candidate and the optimal timing of surgery have only occasionally been addressed in the literature. This issue is methodologically challenging to study since studies require large numbers of patients with new-onset partial epilepsy who are followed over time. The purpose of this article is to review the current ability for early prediction of medical intractability in patients with surgically remediable epilepsy. Emphasis will be placed on the early prediction of intractable temporal lobe epilepsy in children and adolescents, since temporal lobectomy remains the prototype epilepsy surgery, and early surgery may improve psychosocial outcome in younger patients.
Insights
Resective epilepsy surgery offers significant seizure reduction for select patients. Early identification of surgical candidates, especially for temporal lobe epilepsy in children, is crucial for optimal outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Medically intractable epilepsy often requires surgical intervention.
- Resective surgery, particularly temporal lobectomy, demonstrates high seizure-free rates in carefully selected patients.
- Predicting surgical outcomes and timing remains an area of active research.
Purpose of the Study:
- To review the current capabilities for early prediction of medical intractability in patients with surgically remediable epilepsy.
- To emphasize the early prediction of intractable temporal lobe epilepsy in pediatric and adolescent populations.
- To highlight the importance of early surgical intervention for improving psychosocial outcomes in younger patients.
Main Methods:
- Literature review focusing on predictors of outcome in epilepsy surgery.
- Analysis of studies addressing early identification and optimal timing of epilepsy surgery.
- Emphasis on research concerning temporal lobe epilepsy in children and adolescents.
Main Results:
- Temporal lobectomy achieves 65-70% seizure-free rates in adults and 68-78% in children.
- Extratemporal resections show lower seizure-free rates, though some series report up to 62% in children.
- Many patients experience seizure reduction without complete freedom post-surgery.
Conclusions:
- Resective surgery is effective for carefully selected epilepsy patients.
- Early identification and intervention in pediatric temporal lobe epilepsy are critical.
- Further research is needed to address methodological challenges in predicting surgical candidacy and timing.