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Effectiveness and Safety of Epilepsy Surgery for Pediatric Patients with Intractable Epilepsy: A Clinical
Müge Dolgun1, Duygu Dölen2, Emek Uyur Yalçın3
1Department of Neurosurgery, Haseki Training and Research Hospital, Istanbul, Turkey.
Insights
Pediatric epilepsy surgery offers favorable seizure control for drug-resistant epilepsy (DRE) across age groups. Both invasive monitoring and surgery demonstrate effectiveness, with a need for further research in younger children.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Epileptology
Background:
- Pediatric epilepsy surgery is a key treatment for drug-resistant epilepsy (DRE).
- Early surgical intervention in children improves seizure control and neurophysiological outcomes.
- This study evaluates pediatric epilepsy surgery effectiveness and safety by age.
Purpose of the Study:
- To assess the effectiveness and safety of pediatric epilepsy surgery.
- To compare surgical outcomes between pediatric patients younger than 3 years and older than 3 years.
- To evaluate the role of invasive monitoring in relation to pathological results and seizure outcomes.
Main Methods:
- Retrospective, single-center study of 60 pediatric patients (2002-2018).
- Patients categorized into two age groups: ≤3 years and >3 years.
- Outcomes assessed: seizure control (Engel's classification), morbidity, mortality, and invasive monitoring effectiveness over an 8.7-year follow-up.
Main Results:
- Overall favorable seizure outcome (Engel I-II) in 56.6% of patients.
- Patients >3 years old showed a higher favorable outcome rate (60.4%) compared to those ≤3 years (47%).
- Postoperative morbidity was 35%, and mortality was 1.6%.
Conclusions:
- Pediatric epilepsy surgery is crucial for cognitive preservation and treating DRE.
- Both invasive monitoring and epilepsy surgery yield favorable outcomes across pediatric age groups.
- Further research is needed to confirm safety and efficacy, especially for children under three.
Introduction:
Pediatric epilepsy surgery is an effective treatment modality for patients with drug-resistant epilepsy (DRE). Early pediatric surgery yields favorable results for DRE in terms of seizure control and neurophysiological outcome. In this study, pediatric patients were categorized based on their age (above 3 years old and below 3 years old) to demonstrate the effectiveness and safety of surgical procedures.
Methods:
In this retrospective, single-center study, 60 pediatric patients who underwent epilepsy surgery at Istanbul Faculty of Medicine between 2002 and 2018 were evaluated. Overall morbidity and mortality rates, as well as seizure outcomes of the patients, were assessed and compared based on two age groups: those aged 3 years old or younger and those older than 3 years old. The effectiveness of invasive monitoring was also evaluated in relation to pathological results. The postoperative seizure outcome rates were evaluated using Engel's classification, with an average follow-up period of 8.7 years.
Results:
Out of the total number of patients, 47 (78.4%) underwent resective surgery, while 13 (21.6%) had palliative surgery. Ten patients (16.6%) had invasive monitoring. Among all patients, 34 were classified as Engel I and II (56.6%), while 26 were classified as Engel III and IV (43.4%) postoperatively. 47% of patients who were under 3 years old, 60.4% of patients who were over 3 years old, and 50% of patients who underwent invasive monitoring had a favorable seizure outcome (Engel I-II). Postoperative morbidity and mortality rates were 35% (n = 21) and 1.6% (n = 1), respectively.
Conclusion:
Pediatric epilepsy surgery is an important treatment modality for preserving cognitive abilities and providing effective treatment for pediatric DRE. In our study, we claim that both invasive monitoring and epilepsy surgery lead to favorable seizure outcomes for all age groups. Further clinical studies should be conducted to provide more reliable data on the safety and effectiveness of the surgery, particularly in patients under the age of three.
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