Seizure outcome of intractable partial epilepsy in children
Lan S Chen1, Nina Wang, Meei-Ing Lin
1Division of Neurology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 90027, USA.
Insights
For children with intractable partial epilepsy, surgery evaluation is key. Epilepsy surgery offers excellent outcomes for many, especially those with focal lesions unresponsive to medication.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Intractable partial epilepsy in children necessitates understanding surgical outcomes.
- Evaluating surgery candidacy requires predicting benefits and likelihood of success.
Purpose of the Study:
- To analyze seizure outcomes in children with intractable partial epilepsy.
- To identify factors influencing outcomes after antiepileptic drug treatment and epilepsy surgery.
Main Methods:
- Retrospective review of 50 children with intractable partial epilepsy (video-EEG confirmed, weekly seizures).
- Analysis of outcomes after 2+ years of follow-up, comparing antiepileptic drug treatment versus epilepsy surgery.
- Identification of risk factors for poor seizure control.
Main Results:
- Only 30% of children on antiepileptic drugs achieved excellent long-term seizure control.
- Epilepsy surgery achieved excellent outcomes in 60% of patients, even with focal neuroimaging abnormalities.
- Focal lesions on neuroimaging were the sole predictor of poor outcomes in the drug-treated group.
Conclusions:
- Children with partial epilepsy refractory to antiepileptic drugs after one year warrant epilepsy surgery evaluation.
- Early surgical consideration is particularly crucial for patients with focal neuroimaging lesions.
- Epilepsy surgery can provide significant seizure control benefits for carefully selected pediatric patients.
Abstract:
The intractable partial epilepsy outcome information is important in determining not only when epilepsy surgery evaluation should begin but also in deciding who would benefit and what is the likelihood of any benefit from surgery. Medical records of 50 children diagnosed with nontumor-related partial seizures, confirmed by video-electroencephalography (video-EEG), had at least one seizure per week and were followed for at least 2 consecutive years after video-EEGs were reviewed. There were 30 patients who continued with antiepileptic drug treatment after video-EEG. The seizure outcome analysis revealed a significant improvement of seizure control in the first year of follow-up but no difference between the first year and the following 3 years. Only 30% had excellent long-term outcome (seizure free or less than one seizure per 6 months). The presence of focal lesions on neuroimaging was the only risk factor of poor outcome. The other 20 patients underwent epilepsy surgery after video-EEG; 60% attained excellent outcome despite the fact that 90% had focal neuroimaging abnormality. Children whose partial epilepsy remained intractable after 1 year of antiepileptic drug treatment should be evaluated for candidacy of epilepsy surgery, particularly those who have focal lesions on neuroimaging.
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