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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Drug-resistant temporal lobe epilepsy: Seizure outcome in children versus adults
Gurumurthy Bharanidharan1, Ankith Bhasi1, Mathew Abraham1
1R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Insights
Children with temporal lobe epilepsy (TLE) experience better surgical outcomes than adults, highlighting the importance of early intervention. Catching them young can significantly improve seizure freedom and long-term results.
Area of Science:
- Neurology
- Epileptology
- Pediatric Neurology
Background:
- Temporal lobe epilepsy (TLE) is the most common focal epilepsy, with many drug-resistant cases eligible for surgery.
- While pediatric TLE surgery outcomes are often favorable, direct comparisons with adult outcomes using the same surgical procedures are limited.
Purpose of the Study:
- To compare long-term seizure outcomes between pediatric and adult patients undergoing TLE surgery.
- To identify prognostic factors influencing surgical success in both age groups.
Main Methods:
- A cohort of 684 patients (127 children, 557 adults) underwent standard anterior temporal lobectomy.
- Presurgical evaluation included video EEG and neuroimaging; seizure freedom was the primary outcome.
- Logistic regression and Kaplan-Meier curves were used to analyze predictors and long-term seizure-free survival.
Main Results:
- Children had shorter epilepsy duration (8.38 vs. 19.2 years) and better seizure outcomes (57.4% vs. 45.6%) compared to adults.
- Median seizure-free survival was longer in children (120 months) than adults (72 months).
- Predictors of poor outcome in adults included specific auras and EEG findings; febrile seizures predicted favorable outcomes in both groups. Neoplasia was protective in children, while psychiatric comorbidities predicted recurrence.
Conclusions:
- Pediatric patients demonstrate superior long-term seizure control after TLE surgery compared to adults.
- Earlier surgical intervention in children, evidenced by shorter epilepsy duration, contributes to better outcomes.
- The findings underscore the principle of "time is brain" in epilepsy, advocating for early surgical referral to prevent network expansion and improve seizure control.
Introduction:
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy, and about two-thirds of patients with drug-resistant TLE are surgical candidates. While many studies suggest better postoperative outcomes in children subjected to various types of surgery, there is limited data comparing adults and children who have undergone the same procedure over the same time period. This study aimed to compare long-term seizure outcomes and identify prognostic factors in pediatric (defined as children less than or equal to 12 years) and adult patients undergoing TLE surgery at a high-volume epilepsy center in South India.
Methods:
The study cohort comprised 684 consecutive patients (127 children, 557 adults) who underwent standard anterior temporal lobectomy. All underwent presurgical evaluation including video EEG, neuroimaging, and surgical decision was made in a multidisciplinary meet. Seizure freedom was defined as "absence of seizures or auras regardless of antiepileptic drug use," which was the primary outcome. The predictors determining outcome in both age groups were also analyzed. Logistic regression identified the predictors, and Kaplan-Meier curves assessed long-term seizure-free survival.
Results:
Children had significantly shorter epilepsy duration pre-surgery (8.38 versus 19.2 years, p < .0001) and significantly better seizure outcome (57.4% vs. 45.6%, p = .0165). Kaplan-Meier analysis revealed longer median seizure-free survival in children (120 months) than adults (72 months, p = .027). In adults, predictors of poor outcome included auditory aura, behavioral arrest, spike-wave discharges during ictal onset, and bitemporal IEDs. Febrile seizures predicted a favorable outcome in children and adults. In children, neoplasia as a substrate was protective, while psychiatric co-morbidity and multiple auras predicted seizure recurrence.
Conclusion:
Children benefit more from TLE surgery than adults, due to earlier intervention and shorter duration of seizures. The principle of "time is brain" holds true in epilepsy; prolonged duration of uncontrolled seizures fosters network expansion, highlighting the need for "early surgical referral" and "catching them young."
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