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Seizure outcome after epilepsy surgery in children and adolescents
E Wyllie1, Y G Comair, P Kotagal
1Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA.
Insights
Pediatric epilepsy surgery offers high seizure-free rates for children and adolescents. Early surgical evaluation is recommended for severe, intractable epilepsy, regardless of age.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Limited data exist on epilepsy surgery outcomes in pediatric populations.
- Intractable epilepsy in children and adolescents necessitates effective treatment options.
Purpose of the Study:
- To evaluate seizure outcomes in pediatric patients undergoing epilepsy surgery.
- To compare outcomes between children and adolescents with intractable epilepsy.
Main Methods:
- Retrospective study of 136 pediatric patients (3 months to 20 years) undergoing epilepsy surgery.
- Analysis of seizure outcomes based on age group, surgical procedure, and etiology.
- Postoperative follow-up ranging from 1 to 7.5 years.
Main Results:
- Overall seizure-free rates were comparable across infants (60%), children (68%), and adolescents (69%).
- Temporal resections showed higher seizure-free rates (78%) compared to extratemporal/multilobar resections (54%).
- Patients with tumors (82%) had better outcomes than those with cortical dysplasia (52%).
Conclusions:
- Epilepsy surgery is effective in pediatric patients, with outcomes similar to adult series.
- Age is not a barrier to successful epilepsy surgery in pediatric populations.
- Children with severe, intractable localization-related epilepsy should be considered for surgical evaluation.
Abstract:
Few epilepsy surgery outcome data are available from series of pediatric patients. We studied seizure outcome in 136 pediatric patients who had surgery for intractable epilepsy at The Cleveland Clinic between January 1990 and June 1996, with a postoperative follow-up of 1 to 7.5 years (mean, 3.6 years). Sixty-two children (3 months to 12 years old at time of surgery) were compared with 74 adolescents (13-20 years old). Extratemporal or multilobar resections and hemispherectomies were similarly frequent among children (50%) and adolescents (44%), but these procedures strongly predominated in infancy (90% of patients 0-2 years of age). The remaining patients had temporal resection. Cortical dysplasia and low-grade tumor were the most common causes and hippocampal sclerosis was rare. Seizure-free outcome was achieved for 69% of adolescents, 68% of children, and 60% of the infant subgroup, overall; for 23 (74%) of 31 children and 33 (80%) of 41 adolescents after temporal resection; for 11 (58%) of 19 children and 15 (52%) of 29 adolescents after extratemporal or multilobar resection; and for 8 (67%) of 12 children and 3 (75%) of 4 adolescents after functional hemispherectomy. Seizure-free outcome was more frequent after temporal resection (56 of 72, 78%) than after extratemporal or multilobar resection (26 of 48, 54%; 41 of 48 with a focal lesion on magnetic resonance imaging), and among patients with tumor (36 of 44, 82%) versus cortical dysplasia (16 of 31, 52%). The frequency of seizure-free outcome after epilepsy surgery was similar for infants, children, and adolescents, and comparable with results from adult series. Most patients in each age, surgery type, and causal group were free from seizures after surgery. These results suggest that children should be considered for surgical evaluation at whatever age they manifest with severe, intractable, disabling localization-related epilepsy.