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Published on: August 16, 2024
Seizure outcomes in children with epilepsy after resective brain surgery
Lakshmi Nagarajan1, Michael Lee1, Linda Palumbo1
1Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia.
Insights
Resective brain surgery effectively controls seizures in many children with epilepsy, particularly those with tumors. Intraoperative electrocorticography (ECoG) aids in achieving favorable seizure outcomes.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Epilepsy affects a significant number of children worldwide.
- Refractory epilepsy often necessitates advanced treatment strategies.
- Resective brain surgery is a potential therapeutic option for select pediatric epilepsy cases.
Purpose of the Study:
- To evaluate the efficacy of resective brain surgery in pediatric epilepsy patients.
- To determine seizure-free outcomes and reduction in anti-epileptic drug (AED) usage post-surgery.
- To assess the role of intraoperative electrocorticography (ECoG) in surgical success.
Main Methods:
- Retrospective analysis of 55 children undergoing resective brain surgery (1997-2012).
- Pre-surgical evaluation included V-EEG, MRI, SPECT, and PET scans.
- Intraoperative ECoG was utilized in 54 patients; follow-up ranged from 2 to 16 years.
Main Results:
- 78% of patients achieved an Engel Class 1 outcome (seizure freedom).
- 67% of patients were seizure-free off all AEDs.
- Patients with tumors (56% of cohort) had an 87% Class 1 outcome and 84% were off AEDs; cortical dysplasia group had 56% Class 1 outcome.
Conclusions:
- Resective brain surgery is an effective treatment for selected children with epilepsy.
- Intraoperative ECoG is a valuable tool for guiding cortical resection and improving seizure control.
- Surgery offers a significant chance for seizure freedom and reduced medication dependence in pediatric epilepsy.
Purpose:
To assess the role of resective brain surgery in childhood epilepsy.
Methodology:
We retrospectively analysed the seizure outcomes in 55 children with epilepsy who had resective brain surgery between 1997 and 2012, at our centre. The children were 1.5-18 years at the time of surgery; their seizure onset was between 0.2 andto 15 years of age. 48 had refractory epilepsy. One child died of tumour progression. Follow-up duration in the survivors ranged from 2 to -16 years (mean: 9).Presurgical evaluation included clinical profiles, non-invasive V-EEG monitoring, neuroimaging with MRIs in all; SPECT and PET in selected patients. 54 had intraoperative ECoG.
Results:
An Engel Class 1 outcome was seen in 78% of the cohort, with 67% being off all AEDs at the most recent follow-up. Children with tumours constituted the majority (56%), with 87% of this group showing a Class 1 outcome and 84% being off AEDs. Children with cortical dysplasia had a Class 1 outcome in 56%.
Conclusion:
Resective brain surgery is an efficacious option in some children with epilepsy. We found ECoG useful to tailor the cortical resection and in our opinion ECoG contributed to the good seizure outcomes.
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