Cognitive Function in Preschool Children after Epilepsy Surgery: Rationale for Early Intervention

Freitag, H.; Tuxhorn, Ingrid

doi:10.1111/j.0013-9580.2005.03504.x

Cited by 268 publications

(214 citation statements)

References 54 publications

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“…14,49 In children with treatment-resistant epilepsy, better seizure control can result in improved developmental and cognitive outcome and quality of life. 13,18,27,28,31,54 Moreover, numerous studies found that VNS can benefit attention, cognition, behavior, mood, and quality of life independent of reduced seizure burden. 1,22,24,25,35,41 These findings suggest that consideration of VNS earlier in the course of refractory disease is warranted.…”

Section: Seizure Control and Developmentmentioning

confidence: 99%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

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Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1–18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days–11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children.

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Section: Seizure Control and Developmentmentioning

confidence: 99%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

View full text Add to dashboard Cite

show abstract

“…Moreover, while seizure freedom is important, preventing cognitive and developmental decline or stagnation may be an equally valid if not a more practical and important measure of surgical success, especially since children with refractory epilepsy are at considerable risk for cognitive impairment and consequent poor school performance and behavior problems. 2,3,7,8,11,24,27 With surgical success being measured not only by seizure freedom but also by developmental outcome, the pool of patients who may potentially benefit from this treatment modality greatly increases. The size of the patient pool further increases if epilepsy surgery becomes part of a multimodal treatment regimen in which attempts at preventing developmental stagnation and controlling seizures are made by multiple available avenues including medical therapy, invasive surgery, and VNS.…”

mentioning

confidence: 99%

Expanding the role of surgery in intractable extratemporal pediatric epilepsy

Goyal

Robinson

2008

FOC

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The aim of epilepsy surgery in children is not only to control seizures but also to curtail future adverse neurological sequelae and improve quality of life. If presurgical evaluation demonstrates discordant or multifocal disease, intracranial surgery may be denied as a viable treatment option. When surgical therapy is offered not just as curative but also as palliative therapy, many children not considered optimal surgical candidates may benefit. From a consecutive series of 57 cases involving children who underwent intracranial epilepsy surgery at Rainbow Babies and Children's Hospital during 2001–2005, the authors present in detail 3 cases involving children who benefited significantly from such an aggressive approach. Marked improvement occurred not only in seizure control, but also in developmental and social functioning.

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“…6) Furthermore, the need for early surgical intervention after onset of medically refractory epilepsy is supported by studies demonstrating better seizure outcome and improved development in patients with shorter epilepsy duration. 2,8,10) Thus, early surgical intervention is mandatory in cases of intractable epilepsy with extensive MCDs in infants.…”

Section: Discussionmentioning

confidence: 99%

Posterior Disconnection in Early Infancy to Treat Intractable Epilepsy With Multilobar Cortical Dysplasia

Liang

Otsuki

Takahashi

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Extensive multilobar cortical dysplasias occasionally occur in children and can induce seizure onset in early infancy, causing severe epileptic encephalopathy. Surgical interventions in early infancy, such as disconnection of large parts of the brain, are challenging because of the degree of invasiveness and carry greater risks in infants compared with older children. Here we report the successful treatment of intractable epilepsy with multilobar cortical dysplasias in the posterior cortex by posterior disconnection in three infants (age 3 months). The patients showed good postoperative recovery and exhibited excellent seizure control at follow-up evaluation within a year after surgery. Developmental catch-up was also achieved and no early complications have been detected to date. Use of the posterior disconnection technique for early-stage extensive multilobar cortical dysplasias can result in good seizure control and developmental progress with little perioperative morbidity. However, the efficacy of this surgical technique needs to be verified with long-term follow up after surgery.

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Cognitive Function in Preschool Children after Epilepsy Surgery: Rationale for Early Intervention

Cited by 268 publications

References 54 publications

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Expanding the role of surgery in intractable extratemporal pediatric epilepsy

Posterior Disconnection in Early Infancy to Treat Intractable Epilepsy With Multilobar Cortical Dysplasia

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