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Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
No deterioration in epilepsy and motor function in children with medically intractable epilepsy ineligible for
Ron van Empelen1, Paul J M Helders, Peter C van Rijen
1Department of Paediatric Physical Therapy and Exercise Physiology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Wilhelmina Children's Hospital, Utrecht, the Netherlands. r.vanempelen@umcutrecht.nl
Insights
In children with medically intractable epilepsy ineligible for surgery, seizure severity and motor impairments remained stable over two years. Functional skills improved, and caregiver assistance decreased, indicating no worsening of daily life activities or restrictions.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Epileptology
Background:
- Medically intractable epilepsy in children often presents challenges beyond seizures, impacting motor function and daily life.
- Children ineligible for epilepsy surgery require long-term management strategies to optimize outcomes.
- Understanding the natural course of motor function and daily living in this population is crucial for care planning.
Purpose of the Study:
- To investigate changes in seizure severity, motor functioning, and epilepsy-related restrictions over two years.
- To assess the progression of motor impairments and functional skills in non-surgical pediatric epilepsy patients.
- To determine if medically intractable epilepsy leads to deterioration in motor development and daily activities in children.
Main Methods:
- Prospective, longitudinal study with 2-year follow-up of 28 children with medically intractable epilepsy.
- Assessment of seizure severity, motor impairments (strength, range of motion, tone), motor development, daily activities, and restrictions at baseline and 24 months.
- Utilized the Gross Motor Function Measure to evaluate motor function changes in children with spasticity.
Main Results:
- Seizure severity, muscle strength, range of motion, and muscle tone showed no significant changes.
- Motor retardation was common, but did not worsen in children without spasticity.
- Children with spasticity demonstrated improved motor function (p < 0.05), though remaining below reference values.
- Overall functional skills increased, and the need for caregiver assistance decreased over the study period.
- Epilepsy-related restrictions remained stable throughout the 2-year follow-up.
Conclusions:
- Children with medically intractable epilepsy, ineligible for surgery, experience stable seizure severity and motor impairments over two years.
- Motor development does not necessarily worsen, and functional skills can improve in this cohort.
- Non-surgical management appears to prevent deterioration in daily living activities and associated restrictions in pediatric epilepsy.
Abstract:
The aim of this study was to examine whether severity of epilepsy, motor functioning, and epilepsy-related restrictions change in children with medically intractable epilepsy who are ineligible for epilepsy surgery. The study was a prospective, longitudinal, 2-year follow-up of 28 children (14 females, 14 males). Their median age was 6 years 1 month (range 7mo-15y 4mo). Seizure types were: complex partial seizures (n=16), secondary generalized seizures (n=7), simple partial seizures (n=2), and mixed seizures (n=3). Severity of seizures, motor impairments, motor development, activities of daily life, and epilepsy-related restrictions were rated at baseline and 6, 12, and 24 months thereafter. Seizure severity did not change significantly, nor did muscle strength, range of motion, or muscle tone. Motor retardation was ubiquitous but did not increase in 20 children without spasticity. Motor function of eight children with spasticity improved (Gross Motor Function Measure: baseline 70.5 [SD 35.5]; 24 months later 81.6 [SD 29.6], p < 0.05) but remained below reference values in four children. In the entire group, functional skills increased and caregiver assistance lessened. Restrictions did not change significantly. We conclude that during a 2-year follow-up period, in children with medically intractable epilepsy who do not have surgical intervention, seizure severity does not deteriorate, motor impairments do not increase, motor development does not deflect negatively, and activities of daily living and restrictions do not worsen.
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