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[Results of surgery treatment of epilepsy]
L A Alvarez1, T J Resnick, M S Duchowny
1Departamento de Neurología, Miami Children's Hospital, Florida 33115-4079, USA. LaafCane@aol.com
Insights
Epilepsy surgery outcomes have improved, especially for children, offering better psychosocial development. Current evaluation methods vary, highlighting the need for a standardized approach to assess seizure control and psychosocial impact.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Neurology
Context:
- Advances in epilepsy surgery have significantly improved patient outcomes.
- Pediatric epilepsy surgery now offers results comparable to adults, with potential for enhanced psychosocial development.
- Children's brain plasticity may allow better tolerance of eloquent cortex resection without permanent deficits.
Purpose:
- To highlight the significant improvements in epilepsy surgery outcomes, particularly in the pediatric population.
- To address the variability in reported surgical outcomes due to differing evaluation methodologies and patient selection criteria.
- To propose the development of an optimal, standardized method for evaluating epilepsy surgery results, encompassing both seizure control and psychosocial outcomes.
Summary:
- Epilepsy surgery demonstrates high success rates, with temporal lobectomy achieving 68-90% seizure-free outcomes and extratemporal resections achieving 50-66%.
- Significant inter-center variability exists in reported outcomes, stemming from diverse patient selection and result evaluation methods.
- There is a critical need for a unified methodology to assess epilepsy surgery effectiveness, integrating seizure control with psychosocial well-being.
Impact:
- Improved surgical candidate selection and outcome prediction through a standardized evaluation method.
- Enhanced quality of life for epilepsy patients, especially children, by optimizing surgical interventions.
- Advancement of evidence-based practices in neurosurgery for epilepsy management.
Abstract:
The recent advances in the surgical treatment of epilepsy have resulted in great improvement in the overall outcome of these patients. The pediatric group has probably benefited the most as patients who previously were not candidate for this form of treatment are now able to undergo epilepsy surgery with results which are as good as those of adults. In fact, children may now benefit the most, as the control of their epilepsy and our ability to stop their anticonvulsants may allow them to better develop from a psychosocial aspect. Also, because of their plasticity, young children may tolerate surgery involving loss of eloquent cortex without subsequent permanent deficits. The most recent reported results from different centers indicate that 68-90% of patients undergoing temporal lobectomy remain seizure free while the percentage of patients remaining seizure free after extratemporal resections is approximately 50-66%. However, one of the problems with these results is that they vary significantly from one center to another because of the methodology used to evaluate results and the selection of patients depending on the strength of the centers. At present we do not have an optimal method to evaluate results of epilepsy surgery that takes in consideration not only seizure control but also psychosocial outcome. It is our goal to develop such method which will ultimately help us identify the best surgical candidates and predict their outcome.