Abstract
Object
Surgery is an effective treatment for selected patients with intractable epilepsy. The authors report the outcomes of focal resection in a series of children suffering from intractable focal epilepsy treated at a single institution.
Methods
The authors retrospectively analyzed a series of 58 consecutive children who underwent surgery between 1998 and 2006 for intractable localized epilepsy at Primary Children’s Medical Center. Evaluation for surgery and follow-up was performed by the authors in the combined Pediatric Epilepsy Surgery Clinic.
Results
Preoperative seizure duration ranged from 6 months to 15 years. The cause of epilepsy was mesial temporal sclerosis (MTS) in 16 patients, dual pathology (MTS plus another lesion) in 3 patients, low-grade tumors in 16 patients, cortical dysplasia (CD) in 13 patients, cavernous malformation (CM) in 5 patients, and other conditions in 5 patients. In 33 cases, the lesions were in the temporal lobe, and in 25 cases, the lesions were extratemporal. At last follow-up, 74% (43/58) of all patients were seizure-free; seizure-free rates for specific conditions were 88% (14/16) for MTS, 33% (1/3) for dual pathology, 81% (13/16) for tumor, 62% (8/13) for CD, and 80% (4/5) for CM. Seizure-free rates were 85% (28/33) for temporal locations and 60% (15/25) for extratemporal locations. There were no permanent neurological complications or deaths.
Conclusion
Surgery for localized epilepsy in carefully selected children has good seizure control rates with minimal complications. Outcomes for patients with resections in temporal locations were better than those for patients with extratemporal resections.
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References
Blume WT (1997) Temporal lobe epilepsy surgery in childhood: rationale for greater use. Can J Neurol Sci 24:95–98
Bourgeois M, Sainte-Rose C, Lellouch-Tubiana A, Malucci C, Brunelle F, Maixner W, Cinalli G, Pierre-Kahn A, Renier D, Zerah M, Hirsch JF, Goutieres F, Aicardi J (1999) Surgery of epilepsy associated with focal lesions in childhood. J Neurosurg 90:833–842
Chuang SH, Otsubo H, Hwang P, Orrison WW Jr, Lewine JD (1995) Pediatric magnetic source imaging. Neuroimaging Clin N Am 5:289–303
Chugani HT (1994) The role of PET in childhood epilepsy. J Child Neurol 9(Suppl 1):S82–S88
Chugani HT, Shields WD, Shewmon DA, Olson DM, Phelps ME, Peacock WJ (1990) Infantile spasms: I. PET identifies focal cortical dysgenesis in cryptogenic cases for surgical treatment. Ann Neurol 27:406–413
Cohen-Gadol AA, Wilhelmi BG, Collignon F, White JB, Britton JW, Cambier DM, Christianson TJ, Marsh WR, Meyer FB, Cascino GD (2006) Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. J Neurosurg 104:513–524
Dam M (1990) Children with epilepsy: the effect of seizures, syndromes, and etiological factors on cognitive functioning. Epilepsia 31(Suppl 4):S26–S29
Devinsky O, Perrine K, Vazquez B, Luciano DJ, Dogali M (1994) Multiple subpial transections in the language cortex. Brain 117(Pt 2):255–265
Dogali M, Devinsky O, Luciano D, Perrine K (1994) Invasive intracranial monitoring, cortical resection and multiple subpial transection for the control of intractable complex partial seizure of cortical onset. Stereotact Funct Neurosurg 62:222–225
Farwell JR, Dodrill CB, Batzel LW (1985) Neuropsychological abilities of children with epilepsy. Epilepsia 26:395–400
Kloss S, Pieper T, Pannek H, Holthausen H, Tuxhorn I (2002) Epilepsy surgery in children with focal cortical dysplasia (FCD): results of long-term seizure outcome. Neuropediatrics 33:21–26
Liu Z, Zhao Q, Li S, Tian Z, Cui Y, Feng H (1995) Multiple subpial transection for treatment of intractable epilepsy. Chin Med J (Engl) 108:539–541
Mittal S, Montes JL, Farmer JP, Rosenblatt B, Dubeau F, Andermann F, Poulin N, Olivier A (2005) Long-term outcome after surgical treatment of temporal lobe epilepsy in children. J Neurosurg 103:401–412
Morrell F (1989) Varieties of human secondary epileptogenesis. J Clin Neurophysiol 6:227–275
Vickrey BG, Hays RD, Engel J Jr., Spritzer K, Rogers WH, Rausch R, Graber J, Brook RH (1995) Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life. Ann Neurol 37:158–166
Wyler AR, Hermann BP, Richey ET (1989) Results of reoperation for failed epilepsy surgery. J Neurosurg 71:815–819
Wyllie E (1996) Surgery for catastrophic localization-related epilepsy in infants. Epilepsia 37(Suppl 1):S22–25
Wyllie E, Luders H, Morris HH 3rd, Lesser RP, Dinner DS, Hahn J, Estes ML, Rothner AD, Erenberg G, Cruse R et al (1987) Clinical outcome after complete or partial cortical resection for intractable epilepsy. Neurology 37:1634–1641
Yoon HH, Kwon HL, Mattson RH, Spencer DD, Spencer SS (2003) Long-term seizure outcome in patients initially seizure-free after resective epilepsy surgery. Neurology 61:445–450
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We thank Kristin Kraus, M.Sc., for her editorial assistance in preparing this paper.
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Kan, P., Van Orman, C. & Kestle, J.R.W. Outcomes after surgery for focal epilepsy in children. Childs Nerv Syst 24, 587–591 (2008). https://doi.org/10.1007/s00381-007-0545-9
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DOI: https://doi.org/10.1007/s00381-007-0545-9