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Surgical treatment of epilepsy: our experiences with 34 children
I I Ribaric1, M Nagulic, B Djurovic
1Neurosurgical Clinic, University Clinical Center, Belgrade, Yugoslavia.
Insights
Pediatric epilepsy surgery offers hope for children with intractable seizures. This study found 62% of young patients became seizure-free after surgery, demonstrating its effectiveness.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Surgical treatment for medically intractable epilepsy in children is complex due to unique pediatric epilepsy etiologies and brain plasticity.
- Pediatric epilepsy surgery requires specialized approaches compared to adult epilepsy surgery.
Purpose of the Study:
- To evaluate the surgical outcomes for pediatric patients (≤15 years) with medically intractable epilepsy.
- To analyze the efficacy of surgical interventions in different pediatric epilepsy subgroups.
Main Methods:
- Retrospective analysis of 34 pediatric patients (age ≤15 years) who underwent surgery for intractable epilepsy.
- Patients were categorized into four subgroups: temporal foci, extratemporal foci, infantile hemiplegia and epilepsy, and epilepsia partialis continua.
- Preoperative brain lesions and postoperative seizure outcomes were assessed during a 1-14 year follow-up period.
Main Results:
- Out of 34 pediatric patients, 30 (88%) had detectable brain lesions preoperatively.
- Postoperative outcomes showed 21 patients (62%) were seizure-free, 8 (23%) improved, and 5 (15%) had no improvement.
- The mean follow-up duration was 4 years.
Conclusions:
- Surgical intervention can be highly effective in achieving seizure freedom for select pediatric patients with intractable epilepsy.
- The high frequency of preoperative brain lesions in this pediatric cohort warrants further investigation.
- Pediatric epilepsy surgery demonstrates promising results, with a significant majority experiencing seizure reduction or elimination.
Abstract:
Surgical treatment of medically intractable epileptic fits in children is highly specialized, owing to the specific etiology of epilepsies in this age group and the epileptogenic property of the brain in childhood. In our series of 340 patients operated on for medically intractable epileptic seizures, there were 34 (10%) patients up to 15 years of age (the youngest was 2 years old; mean age was 11 years). This group of patients comprises four subgroups: 9 patients with temporal foci, 6 patients with extratemporal foci, 16 patients with infantile hemiplegia and epilepsy, and 3 patients with epilepsia partialis continua (Kozhevnikov's disease). Preoperatively, detectable brain lesions were present in 30 (88%) cases, a much higher frequency than in adult surgical series. Postoperative follow-up so far is 1-14 years (mean, 4 years). Surgical outcome in this group of 34 patients is as follows: 21 (62%) are seizure-free, 8 (23%) have improved, and 5 (15%) have shown no improvement.