Outcomes of disconnective surgery in intractable pediatric hemispheric and subhemispheric epilepsy
Santhosh George Thomas1, Ari George Chacko, Maya Mary Thomas
1Division of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India.
Insights
Disconnective epilepsy surgery, including peri-insular hemispherotomy, offers excellent seizure control for pediatric epilepsy. Older age at seizure onset and specific etiologies predict successful surgical outcomes.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Epileptology
Background:
- Intractable pediatric epilepsy often requires surgical intervention.
- Disconnective epilepsy surgery aims to control seizures by isolating affected brain regions.
Purpose of the Study:
- To evaluate the efficacy of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy.
- To identify predictors of successful seizure control post-surgery.
Main Methods:
- Retrospective analysis of 34 pediatric patients (<18 years) undergoing peri-insular hemispherotomy (PIH) or peri-insular posterior quadrantectomy (PIPQ) between 2000-2011.
- Pre-surgical evaluation, annual cognitive assessments, and seizure outcome assessment using Engel's classification.
Main Results:
- 91.1% of patients achieved seizure freedom at a mean follow-up of 30.5 months.
- Rasmussen's encephalitis (RE), Sturge Weber syndrome (SWS), and post-encephalitic sequelae (PES) were common etiologies.
- Age of seizure onset and epilepsy etiology predicted Class I seizure outcome.
Conclusions:
- Disconnective epilepsy surgery demonstrates excellent seizure outcomes in pediatric patients with intractable hemispheric and sub-hemispheric epilepsy.
- Older age at seizure onset, RE, SWS, and PES are favorable prognostic indicators for achieving seizure freedom.
Objectives:
To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy.
Methods:
A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel's classification and cognitive skills by appropriate measures of intelligence that were repeated annually.
Results:
There were 34 patients in all. Epilepsy was due to Rasmussen's encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome.
Conclusions:
There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.
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