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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Unexpected marked seizure improvement in paediatric epilepsy surgery candidates
Christina E Hoei-Hansen1, René Mathiasen1, Peter Uldall2
1Department of Paediatrics, University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Some children with refractory epilepsy achieve seizure freedom unexpectedly during evaluation for epilepsy surgery. This improvement sometimes leads to withdrawal from the surgical program, with a significant portion remaining seizure-free long-term.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Epilepsy surgery is typically reserved for medically refractory cases, assuming continued seizures.
- Unexpected seizure remission can occur during the pre-surgical evaluation period.
Purpose of the Study:
- To determine the incidence of children withdrawn from epilepsy surgery programs due to spontaneous seizure improvement.
- To characterize these cases and their long-term outcomes.
Main Methods:
- Retrospective review of 173 children under 18 with medically refractory epilepsy evaluated for surgery (1996-2010).
- Medical records analyzed in 2012 and 2015 to identify patients withdrawn from the program.
- Detailed analysis of seizure history, treatment changes, and outcomes for withdrawn patients.
Main Results:
- Thirteen patients (7.5%) were withdrawn due to marked seizure improvement by 2012.
- Six of these 13 patients remained seizure-free by 2015, with improvement linked to AED changes or febrile episodes.
- The withdrawn group had a history of significant seizure burden and normal IQs; etiologies included focal cortical dysplasia and heterotopia.
Conclusions:
- Spontaneous seizure control is a possibility during the epilepsy surgery evaluation process.
- This phenomenon can lead to successful program withdrawal and sustained seizure freedom in some pediatric epilepsy cases.
Purpose:
Epilepsy surgery is performed based on the assumption that medical refractory epilepsy will continue. Rarely seizure freedom occurs before surgery is performed, while the patient is being evaluated as an epilepsy surgery candidate. The aim of this study was to describe the number of children withdrawn from an epilepsy surgery programme due to unexpected seizure improvement.
Methods:
We retrospectively studied 173 children under 18 years with medical refractory epilepsy referred for epilepsy surgery between 1996 and 2010. Medical records were reviewed in 2012 and 2015.
Results:
At the first evaluation point in 2012, 13 patients were withdrawn from the epilepsy surgery programme due to unexpected marked improvement. In 2015, 6 of them were still seizure free. They had unexpected seizure freedom due to change in AED treatment (n=3) or after a febrile episode (n=3). The mean number of years they had had seizures was 3.4 years (range 0.6-6.2 years) and the number of seizures at inclusion was 209 per month (range 6-750 per month). The duration of follow-up was 6.6 years after inclusion into the epilepsy surgery programme (range 4.0-13.0 years). The aetiology of the epilepsy for these patients was heterotopia (n=1), focal cortical dysplasia (n=3), infarction (n=1) and unknown, with normal MRI (n=1). They all had an IQ in the normal range. Two of the remaining 7 children were operated later.
Conclusion:
Unexpected seizure control may occur during epilepsy surgery evaluation.
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