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Surgical treatment of refractory epilepsy

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Opinion statement

The extension of cortical resection to treat children with intractable epilepsy is one of the most exciting advances in pediatric neurology in the past two decades. Many children with epilepsy who previously had little hope have been given a new chance at life. Many patients who were not considered for surgery are now recognized to be excellent surgical candidates. Most notably, children with generalized seizures such as infantile spasms or gelastic seizures caused by hypothalamic hamartomas now have the opportunity to benefit from surgery. In adults, there is one goal for epilepsy surgery: freedom from seizures. This is an important goal but it is not the only one in children. It may not even be the most important goal. When operating on young children with epilepsy, we seek to alter the long-term developmental and behavioral outcome. Although there are many significant recent advances in pediatric epilepsy surgery, three are particularly important. These are 1) hemispherotomy for children who require hemispheric resection; 2) resection of hypothalamic hamartomas through an innovative transcallosal approach; and 3) resection of multiple tubers in children with tuberous sclerosis complex.

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References and Recommended Reading

  1. Bailet LL, Turk WR: The impact of childhood epilepsy on neurocognitive and behavioral performance: a prospective longitudinal study. Epilepsia 2000, 41:426–431.

    Article  PubMed  CAS  Google Scholar 

  2. Hershey T, Craft S, Glauser TA, Hale S: Short-term and long-term memory in early temporal lobe dysfunction. Neuropsychology 1998, 12:52–64.

    Article  PubMed  CAS  Google Scholar 

  3. Donner EJ, Smith CR, Snead OC III: Sudden unexplained death in children with epilepsy. Neurology 2001, 57:430–434.

    PubMed  CAS  Google Scholar 

  4. Clusmann H, Kral T, Gleissner U, et al.: Analysis of different types of resection for pediatric patients with temporal lobe epilepsy. Neurosurgery 2004, 54:847–859.

    Article  PubMed  Google Scholar 

  5. Kossoff EH, Vining EP, Pillas DJ, et al.: Hemispherectomy for intractable unihemispheric epilepsy etiology vs outcome. Neurology 2003, 61:887–890.

    PubMed  CAS  Google Scholar 

  6. Mathern GW, Giza CC, Yudovin S, et al.: Postoperative seizure control and antiepileptic drug use in pediatric epilepsy surgery patients: the UCLA experience, 1986–1997. Epilepsia 1999, 40:1740–1749.

    Article  PubMed  CAS  Google Scholar 

  7. Hermann B, Seidenberg M, Bell B, et al.: The neurodevelopmental impact of childhood-onset temporal lobe epilepsy on brain structure and function. Epilepsia 2002, 43:1062–1071.

    Article  PubMed  Google Scholar 

  8. Holmes GL, Ben-Ari Y: Seizures in the developing brain: perhaps not so benign after all. Neuron 1998, 21:1231–1234.

    Article  PubMed  CAS  Google Scholar 

  9. Devlin AM, Cross JH, Harkness W, et al.: Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain 2003, 126:556–566.

    Article  PubMed  CAS  Google Scholar 

  10. Lendt M, Gleissner U, Helmstaedter C, et al.: Neuropsychological outcome in children after frontal lobe epilepsy surgery. Epilepsy Behav 2002, 3:51–59.

    Article  PubMed  Google Scholar 

  11. Andermann LF, Savard G, Meencke HJ, et al.: Psychosis after resection of ganglioglioma or DNET: evidence for an association. Epilepsia 1999, 40:83–87.

    Article  PubMed  CAS  Google Scholar 

  12. Villemure JG, Mascott CR: Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 1995, 37:975–981.

    Article  PubMed  CAS  Google Scholar 

  13. Cook SW, Nguyen ST, Hu B, et al.: Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg 2004, 100:125–141. This is an excellent review of the three major types of hemispherectomy in children and gives very good outcome data.

    Article  PubMed  Google Scholar 

  14. Berkovic SF, Arzimanoglou A, Kuzniecky R, et al.: Hypothalamic hamartoma and seizures: a treatable epileptic encephalopathy. Epilepsia 2003, 44:969–973.

    Article  PubMed  Google Scholar 

  15. Frattali CM, Liow K, Craig GH, et al.: Cognitive deficits in children with gelastic seizures and hypothalamic hamartoma. Neurology 2001, 57:43–46.

    PubMed  CAS  Google Scholar 

  16. Weissenberger AA, Dell ML, Liow K, et al.: Aggression and psychiatric comorbidity in children with hypothalamic hamartomas and their unaffected siblings. J Am Acad Child Adolesc Psychiatry 2001, 40:696–703.

    Article  PubMed  CAS  Google Scholar 

  17. Kuzniecky R, Guthrie B, Mountz J, et al.: Intrinsic epileptogenesis of hypothalamic hamartomas in gelastic epilepsy. Ann Neurol 1997, 42:60–67.

    Article  PubMed  CAS  Google Scholar 

  18. Cascino GD, Andermann F, Berkovic SF, et al.: Gelastic seizures and hypothalamic hamartomas: evaluation of patients undergoing chronic intracranial EEG monitoring and outcome of surgical treatment. Neurology 1993, 43:747–750.

    PubMed  CAS  Google Scholar 

  19. Rosenfeld JV, Harvey AS, Wrennall J, et al.: Transcallosal resection of hypothalamic hamartomas, with control of seizures, in children with gelastic epilepsy. Neurosurgery 2001, 48:108–118. This is the Australian group that devised the innovative transcallosal approach to HH. Their work is being extended to many other centers around the world and can be considered a major advancement in the treatment of children who were previously poorly controlled by any other means.

    Article  PubMed  CAS  Google Scholar 

  20. Likavec AM, Dickerman RD, Heiss JD, Liow K: Retrospective analysis of surgical treatment outcomes for gelastic seizures: a review of the literature. Seizure 2000, 9:204–207.

    Article  PubMed  CAS  Google Scholar 

  21. Yu-tse N, Kerrigan JF, Rekate HL: Transcallosal resection of hypothalamic hamartoma in the treatment of refractory epilepsy. Epilepsia 2003, 44(Suppl):158.

    Google Scholar 

  22. Elterman RD, Shields WD, Mansfield KA, Nakagawa J: US Infantile Spasms Vigabatrin Study Group. Randomized trial of vigabatrin in patients with infantile spasms. Neurology 2001, 57:1416–1421.

    PubMed  CAS  Google Scholar 

  23. Koh S, Jayakar P, Dunoyer C, et al.: Epilepsy surgery in children with tuberous sclerosis complex: presurgical evaluation and outcome. Epilepsia 2000, 41:1206–1213.

    Article  PubMed  CAS  Google Scholar 

  24. Karenfort M, Kruse B, Freitag H, et al.: Epilepsy surgery outcome in children with focal epilepsy due to tuberous sclerosis complex. Neuropediatrics 2002, 33:255–261.

    Article  PubMed  CAS  Google Scholar 

  25. Shepard CW, Houser OW, Gomez MR: MR findings in tuberous sclerosis complex and correlation with seizure development and mental impairment. Am J Neuroradiol 1995, 16:149–155.

    Google Scholar 

  26. Jansen FE, Braun KP, van Nieuwenhuizen O, et al.: Diffusion-weighted magnetic resonance imaging and identification of the epileptogenic tuber in patients with tuberous sclerosis. Arch Neurol 2003, 60:1580–1584.

    Article  PubMed  Google Scholar 

  27. Juhasz C, Chugani DC, Muzik O, et al.: Alpha-methyl-Ltryptophan PET detects epileptogenic cortex in children with intractable epilepsy. Neurology 2003, 60:960–968.

    PubMed  CAS  Google Scholar 

  28. Weiner HL, Jerraris N, Lajoie J, et al.: Epilepsy surgery for children with tuberous sclerosis complex. J Child Neurol, in press. The NYU group developed the aggressive protocol for resection of multiple tubers in children with TSC. This has may have a very significant impact on the way we think about patients who do not have a single epileptogenic focus.

  29. Romanelli P, Najjar S, Weiner HL, Devinsky O: Epilepsy surgery in tuberous sclerosis: multistage procedures with bilateral or multilobar foci. J Child Neurol 2002, 17:689–692.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Neurology David Geffen School of Medicine at University of California Los Angeles, 22-474 MDCC, Box 91572, 90095, Los Angeles, CA, USA

    W. Donald Shields MD

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  1. W. Donald Shields MD
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Shields, W.D. Surgical treatment of refractory epilepsy. Curr Treat Options Neurol 6, 349–356 (2004). https://doi.org/10.1007/s11940-996-0027-5

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  • DOI: https://doi.org/10.1007/s11940-996-0027-5

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