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Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Reoperation for refractory epilepsy in childhood: a second chance for selected patients
Georgia Ramantani1, Karl Strobl, Angeliki Stathi
1*Epilepsy Center, University Hospital Freiburg, Freiburg, Germany; ‡Epilepsy Center Kork, Kehl-Kork, Germany; §Department of General Pediatrics, University Children's Hospital Heidelberg, Germany; ‖Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany; ¶Department of Neuropediatrics and Muscular Disorders, University Children's Hospital Freiburg, Freiburg, Germany; #Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany.
Insights
Pediatric epilepsy reoperations can achieve seizure freedom in 61% of children. Early and extensive resections, particularly for cortical dysplasia, improve outcomes in refractory epilepsy.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Reoperations are common in pediatric epilepsy surgery, especially for young children with severe epilepsy.
- Refractory epilepsy in children often necessitates repeat surgical interventions.
Purpose of the Study:
- To evaluate surgical outcomes of reoperations for refractory childhood epilepsy.
- To identify factors predicting successful reoperation outcomes.
Main Methods:
- Retrospective analysis of 23 pediatric reoperation cases (2000-2011).
- Inclusion of presurgical findings, resection details, and post-operative outcomes.
- Analysis of reasons for initial surgical failure.
Main Results:
- Cortical dysplasia was the primary etiology in 83% of cases.
- Initial surgery failure was due to functional considerations or incorrect delineation of the epileptogenic zone.
- Seizure freedom was achieved in 61% of patients post-reoperation, with significant improvement in 26%.
Conclusions:
- Reoperation is effective for selected pediatric refractory epilepsy cases, particularly those with cortical dysplasia.
- Extensive resections and early surgical intervention correlate with better seizure control.
- Performing reoperations at a younger age may enhance neurological recovery due to plasticity.
Background:
Reoperations account for >10% in pediatric epilepsy surgery cohorts, and they are especially relevant in young children with catastrophic epilepsy.
Objective:
To determine surgical outcomes and their predictive factors in reoperations for refractory epilepsy in childhood.
Methods:
We retrospectively analyzed presurgical findings, resections, and outcomes of 23 consecutive children who underwent reoperations from 2000 to 2011.
Results:
Etiology included cortical dysplasia with/without glioneuronal tumor in 19 patients (83%), sole glioneuronal tumor in 2, and tuberous sclerosis and Rasmussen encephalitis in 1 each. The reasons for the failure of the initial surgery were functional considerations in 8 (35%), incorrect delineation of the epileptogenic zone in 8 (35%), and resection not performed as initially planned in 7 (30%) cases. Final procedures included 8 (35%) intralobar, 8 (35%) multilobar resections, and 7 (30%) hemispherotomies. Following reoperations, 14 (61%) patients were seizure free, 6 (26%) showed significant or worthwhile improvement, and 3 (13%) did not respond to surgery. Six of 8 patients who underwent the first resection before the age of 3 years, 6 of 8 whose first resection was limited by functional considerations, and all 7 with hemispherotomy as the final resection achieved seizure freedom after reoperation.
Conclusion:
Reoperation is particularly beneficial for selected children with refractory epilepsy associated with cortical dysplasia that did not respond to an initial limited and/or early resection but achieved seizure freedom after extensive procedures. When indicated, reoperation should be performed at the youngest possible age to profit from higher functional plasticity in compensating for neurological deficit.
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