Surgery for epilepsy due to cortical malformations: ten-year follow-up
Lorie Hamiwka1, Prasanna Jayakar, Trevor Resnick
1Alberta Children's Hospital, Calgary, Alberta, Canada.
Insights
Pediatric epilepsy surgery for cortical malformations yielded positive long-term results. Complete resection significantly improved seizure freedom, especially in cases of developmental tumors.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Malformations of cortical development are a common cause of pediatric epilepsy.
- Surgical intervention is considered for refractory cases.
- Long-term outcomes of epilepsy surgery in this population require further investigation.
Purpose of the Study:
- To evaluate the 10-year seizure outcomes in children with malformations of cortical development who underwent epilepsy surgery.
- To identify factors associated with favorable long-term seizure control.
Main Methods:
- Retrospective analysis of 40 pediatric patients operated on for malformations of cortical development between 1980 and 1992.
- Data collected on age at surgery, seizure type, lesion status, pathology, and surgical resection.
- 10-year follow-up assessment of seizure status.
Main Results:
- Of 38 eligible patients, 40% achieved complete seizure freedom at 10 years post-surgery.
- Seizure freedom rates were higher in patients with developmental tumors (72%) compared to cortical dysplasia (32%).
- Complete surgical resection was a significant predictor of seizure freedom; no incomplete resections resulted in seizure freedom.
Conclusions:
- Epilepsy surgery for pediatric cortical malformations can lead to sustained seizure freedom in a significant proportion of patients.
- Complete resection is crucial for achieving optimal outcomes.
- Histopathological diagnosis influences long-term seizure control, with developmental tumors showing better prognoses than cortical dysplasia.
Abstract:
Children with malformations of cortical development represent a significant proportion of pediatric epilepsy surgery candidates. From a cohort of 40 children operated on between 1980 and 1992 with malformation of cortical development, 38 were alive and had data 10 years after surgery. Age at surgery ranged from 6 months to 18 years (mean, 9.6 years). Thirty-six had partial seizures, and two had infantile spasms; 20 were nonlesional. Pathologic diagnoses were cortical dysplasia (n = 31) and developmental tumor (n = 7). At 10-year follow-up, 15 (40%) were seizure free, 10 (26%) had >90% seizure reduction, and 13 (34%) were improved or unchanged. Children seizure free at two-year follow-up were likely to remain seizure free. Ten-year seizure freedom was 72% in children with developmental tumors and 32% in the cortical dysplasia group. Complete resection was statistically significant for favorable outcome, and no patient with an incomplete resection was seizure free.
