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Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Surgical outcomes and motor function in pediatric peri-Rolandic epilepsy: A single center's experience with 152 cases
Qingzhu Liu1, Renqing Zhu2, Yao Wang1
1Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Insights
Surgery for pediatric peri-Rolandic epilepsy offers good seizure control but risks motor deficits. Careful lesion location assessment is crucial to balance seizure freedom and motor function preservation in children.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Clinical Neurology
Background:
- Peri-Rolandic epilepsy in children involves eloquent cortical areas, posing surgical challenges.
- Resective surgery risks permanent neurological deficits, particularly motor impairments.
- Drug-resistant epilepsy in this region requires careful management strategies.
Purpose of the Study:
- To investigate lesion distribution in pediatric peri-Rolandic epilepsy.
- To evaluate surgical outcomes, including seizure control and motor function.
- To determine the relationship between lesion location and postoperative motor deficits.
Main Methods:
- Retrospective analysis of 152 pediatric patients with drug-resistant peri-Rolandic epilepsy.
- Preoperative assessments included VEEG, MRI, PET, and invasive monitoring.
- Outcomes assessed via Engel classification; logistic regression analyzed lesion location impact.
Main Results:
- Most lesions (66%) were in the central operculum.
- 80% of patients achieved seizure freedom (Engel class I).
- Lesion resection in motor cortex areas correlated with long-term motor dysfunction; 27.9% had severe permanent deficits.
Conclusions:
- Pediatric peri-Rolandic epilepsy surgery effectively controls seizures.
- Risk of postoperative motor dysfunction exists and is linked to lesion location.
- Optimizing surgical strategy requires balancing seizure control with motor function preservation.
Objective:
Peri-Rolandic epilepsy in pediatric patients presents unique surgical challenges due to the involvement of eloquent cortical regions, where resective surgery carries risks of permanent neurological deficits. This study investigates lesion distribution, surgical outcomes, and the relationship between lesion location and postoperative motor function in children undergoing surgery for drug-resistant epilepsy in the peri-Rolandic area.
Methods:
This retrospective study included 152 pediatric patients who underwent craniotomy for peri-Rolandic epilepsy between September 2014 and January 2023. Patients met the criteria of drug-resistant epilepsy, peri-Rolandic surgical resection, and a minimum follow-up of 6 months. Preoperative evaluations included video electroencephalography (VEEG), magnetic resonance imaging, and positron emission tomography, with invasive monitoring in select cases. Motor function and seizure outcomes were assessed using Engel classification and multivariate logistic regression to examine correlations between lesion location, motor deficits, and seizure prognosis.
Results:
Lesions were most commonly found in the central operculum, affecting 66% of patients. Postoperative seizure freedom (Engel class I) was achieved in 80% of cases. Among patients with preoperative motor deficits (28%), 39.5% fully recovered after surgery, whereas 27.9% experienced permanent severe impairments. Resecting lesions in the precentral gyrus, paracentral lobule, and premotor cortex was significantly associated with long-term motor dysfunction. There was no significant association between the location of the lesion and postoperative seizure control.
Significance:
Surgery for peri-Rolandic epilepsy in children is effective in achieving seizure control, although it carries risks of motor dysfunction. Lesion location should be carefully considered to optimize surgical outcomes, balancing seizure control with the preservation of motor function.
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