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Outcome of corpus callosotomy and other pediatric epilepsy surgery: parental perceptions
K C Sassower1, D C Rollinson, M Duchowny
1Department of Neurology, Division of Clinical Neurophysiology, Massachusetts General Hospital, Bigelow 12, 55 Fruit Street, Boston, MA 02114, USA.
Insights
Parents prioritize seizure reduction in children with intractable epilepsy, accepting potential side effects from surgery. This highlights the significant impact of chronic childhood epilepsy on families.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Child Psychology
Background:
- Intractable epilepsy significantly impacts children's quality of life.
- Epilepsy surgery is a potential treatment option for medically resistant cases.
- Understanding parental expectations is crucial for informed consent and treatment planning.
Purpose of the Study:
- To assess parental perceptions of epilepsy surgery outcomes in children.
- To evaluate parental willingness to accept specific postoperative deficits in exchange for seizure control.
Main Methods:
- A preoperative telephone survey was conducted with parents of children diagnosed with intractable epilepsy.
- Twenty-seven parents (16 mothers, 11 fathers) of 16 children (ages 6 months-18 years) were interviewed.
- Parents were asked 24 questions regarding their expectations for seizure reduction and acceptable side effects.
Main Results:
- A majority of parents considered surgery successful with ≥75% seizure reduction.
- Parents were willing to accept behavioral deterioration (57% mothers, 50% fathers) and improvement in seizure control.
- Acceptable side effects for seizure reduction included visual field deficits (82% mothers, 67% fathers) and memory deficits (33% mothers, 75% fathers).
Conclusions:
- Parents of children with medically-resistant epilepsy find potential adverse physical and behavioral consequences of surgery acceptable if adequate seizure control is achieved.
- Parental acceptance of postoperative deficits emphasizes the severe burden of chronic childhood epilepsy.
- These findings underscore the importance of aligning surgical outcomes with parental expectations.
Purpose:
Parental perceptions regarding the outcome of epilepsy surgery in their children were assessed preoperatively via telephone survey.
Methods:
Twenty-seven parents - sixteen mothers (MO), eleven fathers (FA) - of sixteen children (nine boys, seven girls; ages 6 months-18 years) with intractable epilepsy (refractory to > or = 3 anticonvulsants) were interviewed. Twenty-four questions were posed during single, 20-minute sessions to both parents.
Results:
A majority of parents (63% MO, 82% FA) would consider epilepsy surgery successful if it achieved > or = 75% seizure reduction. Incomplete seizure control would even be acceptable if the overall number of seizures were reduced (69% MO, 18% FA). In order to gain seizure remissions, behavioral deterioration would be accepted (57% MO, 50% FA). Less than total seizure control would be accepted if surgery produced behavioral improvement (57% MO, 51% FA, Kappa > 0.6). For seizure reduction, parents would accept: visual field deficits (82% MO, 67% FA), short-term memory deficits (33% MO, 75% FA), and speech problems (56% MO, 17% FA).
Conclusion:
Parents of children with medically-resistant seizures perceive adverse physical and behavioral consequences of epilepsy surgery to be acceptable if there is adequate seizure control. Their acceptance of postoperative deficits underscores the magnitude of the handicap produced by chronic childhood epilepsy.
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