Early surgical approaches in pediatric epilepsy — a systematic review and meta-analysis

Frank, Nicole Alexandra; Greuter, Ladina; Guzman, Raphaël; Soleman, Jehuda

doi:10.1007/s00381-022-05699-x

Cited by 3 publications

(8 citation statements)

References 31 publications

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“…In children, ASM withdrawal is associated with improved developmental outcomes. 27 In our study, the 40.5% percentage of children cognitively improved after surgery is largely superior to the 26% indicated in a previous systematic review 13 on early surgical approaches in pediatric epilepsy. In a single US center surgical series, 9 including 31 operated children under 3 years of age, family perception of accelerated development was not confirmed by formal testing, with patients who were severely impaired before surgery continuing to in the severely impaired These largely variable findings might indicate that parallel evaluations of adaptative performances, quality of life, and neuropsychological testing would better weigh the impact of epilepsy surgery on younger children and their families.…”

Section: Discussioncontrasting

confidence: 64%

“…[4][5][6] Some studies 3,7 have suggested that the earlier the age at surgery and the shorter epilepsy duration the better seizure outcome, thus generating a growing interest in surgical treatment for children in pre-school age. [8][9][10][11][12][13] Despite the reported favorable seizure outcomes in over 50% of children operated on before the age of three, [12][13][14] a recent systematic review concluded that evidence supporting the efficacy of surgery in this age group is of low quality. 12 Variables such as the type of epilepsy, etiology, early postoperative seizures, and extent of surgery have been suggested as possible predictors of seizure outcome in infants and toddlers.…”

Section: Introductionmentioning

confidence: 99%

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Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study

Barba,

Pelliccia,

Grisotto

et al. 2024

Epilepsia Open

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ObjectiveTo assess seizure and developmental outcomes, their predictors, and complications in 160 children who, between 1998 and 2022, underwent surgery for lesional epilepsy with curative intent before the age of 3 years. To compare trends in epilepsy surgery in this age group before and after the year 2014.MethodsRetrospective multicenter study. Descriptive and univariate analyses, and multivariable models for all outcomes.ResultsThese 160 patients (76 F; 47.5%) underwent 169 surgeries (age at surgery 20.4 ± 9.4 months). At the last follow‐up (77 ± 57.4 months), 121 patients (75.6%) were in Engel class I, 106 (66.2%) of whom were in Engel class Ia. Antiseizure medications were stopped in 84 patients (52.5%). Complications requiring reoperations were observed in 16 patients (10%; 9.5% of surgeries) and unexpected permanent deficits in 12 (7.5%; 7.1% of surgeries). Postoperative cognitive functions remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Multivariable analyses showed that the probability of achieving Engel class Ia was lower when the duration of epilepsy was longer, patients underwent preoperative video‐EEG, and unexpected postoperative permanent deficits occurred. Cognitive improvement after surgery was associated with lower preoperative seizure frequency, better preoperative developmental level, and a longer postoperative follow‐up. FCDII and tumors were the histopathologies carrying a higher probability of achieving seizure freedom, while polymicrogyria was associated with a lower probability of cognitive improvement. The number of patients operated on after 2014 was higher than before (61.3% vs. 38.7%), with stable outcomes.SignificanceEpilepsy surgery is effective and safe in infants and toddlers, although the complication rate is higher than seen in older patients. Shorter duration of epilepsy, lower seizure frequency, no need for video‐EEG, tumors, and some malformations of cortical development are robust predictors of seizure and cognitive outcome that may be exploited to increase earlier referral.Plain Language SummaryThis study analyzed the results of epilepsy surgery in 160 children who had been operated on before the age of 3 years at four Italian centers between 1998 and 2022. At the last follow‐up (77 ± 57.4 months), 121 patients (75.6%) were free from disabling seizures, of which 106 (66.2%) were completely seizure‐free since surgery. Major surgical complications occurred in 28 patients (17.5%), which is higher than observed with epilepsy surgery in general, but similar to hemispheric/multilobar surgery. Postoperative cognitive function remained unchanged in 56 patients (44.4%), improved in 51 (40.5%), and worsened in 19 (15.1%). Epilepsy surgery is effective and safe in infants and toddlers.

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Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study

Barba,

Pelliccia,

Grisotto

et al. 2024

Epilepsia Open

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“…1,2,[22][23][24] Furthermore, growing evidence supports that early surgical intervention for epilepsy has a favorable impact on outcomes, making duration of epilepsy a modifiable risk factor for poor outcome. 8,[18][19][20]25 This study also provides evidence for favorable efficacy of less-invasive CC techniques, achieving at least parity in outcome. This combined with the reduced morbidity association with those approaches, as demonstrated here, may lead to increased adoption and earlier intervention in appropriate cases.…”

Section: Discussionmentioning

confidence: 61%

“…Knowing that the likelihood of significant seizure reduction is minimal after failing a second ASM and despite good evidence showing better seizure outcomes with callosotomy compared to vagus nerve stimulation and diet, this delay is likely unwarranted 1,2,22–24 . Furthermore, growing evidence supports that early surgical intervention for epilepsy has a favorable impact on outcomes, making duration of epilepsy a modifiable risk factor for poor outcome 8,18–20,25 . This study also provides evidence for favorable efficacy of less‐invasive CC techniques, achieving at least parity in outcome.…”

Section: Discussionmentioning

confidence: 85%

“…Thirty-five patients (42%) reported a focal seizure semiology of whom 32 reported seizures with impaired awareness and 27 had a motor component. Patients had failed a mean of 5.8 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] anti-seizure medications (ASMs) and were currently taking a mean of 3 ASMs (0-6) without adequate control. Other commonly failed therapies included dietary therapy (42%) and vagus nerve stimulation (35%).…”

Section: Resultsmentioning

confidence: 99%

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A multi‐center comparison of surgical techniques for corpus Callosotomy in pediatric drug‐resistant epilepsy

Hansen,

Shandley,

Olaya

et al. 2023

Epilepsia

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ObjectivesCorpus callosotomy (CC) is used to reduce seizures, primarily in patients with generalized drug‐resistant epilepsy (DRE). The invasive nature of the procedure contributes to underutilization despite its potential superiority to other palliative procedures. The goal of this study was to use a multi‐institutional epilepsy surgery database to characterize the use of CC across participating centers.MethodsData were acquired from the Pediatric Epilepsy Research Consortium (PERC) Surgery Database, a prospective observational study collecting data on children 0–18 years referred for surgical evaluation of DRE across 22 U.S. pediatric epilepsy centers. Patient, epilepsy, and surgical characteristics were collected across multiple CC modalities. Outcomes and complications were recorded and analyzed statistically.ResultsEighty‐three patients undergoing 85 CC procedures at 14 participating epilepsy centers met inclusion criteria. Mean age at seizure onset was 2.3 years (0–9.4); mean age for Phase I evaluation and surgical intervention were 9.45 (.1–20) and 10.46 (.2–20.6) years, respectively. Generalized seizure types were the most common (59%). Complete CC was performed in 88%. The majority of CC procedures (57%) were via open craniotomy, followed by laser interstitial thermal therapy (LiTT) (20%) and mini‐craniotomy/endoscopic (mc/e) (22%). Mean operative times were significantly longer for LiTT, whereas mean estimated blood loss was greater in open cases. Complications occurred in 11 cases (13%) and differed significantly between surgical techniques (p < .001). There was no statistically significant difference in length of postoperative stay across approaches. Mean follow‐up was 12.8 months (range 1–39). Favorable Engel outcomes were experienced by 37 (78.7%) of the patients who underwent craniotomy, 10 (58.8%) with LiTT, and 12 (63.2%) with mc/e; these differences were not statistically significant.SignificanceCC is an effective surgical modality for children with DRE. Regardless of surgical modality, complication rates are acceptable and seizure outcomes generally favorable. Newer, less‐invasive, surgical approaches may lead to increased adoption of this efficacious therapeutic option for pediatric DRE.

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microRNA profilings identify plasma biomarkers and targets associated with pediatric epilepsy patients

Wang,

Shi,

et al. 2023

Pediatr Res

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Background Although previous studies show that microRNAs (miRNAs) can potentially be used as diagnostic markers for epilepsy, there are very few analyses of pediatric epilepsy patients. Methods miRNA profiles using miRNA-seq was performed on plasma samples from 14 pediatric epileptic patients and 14 healthy children. miRNA miR-27a-3p that were significantly changed between two groups were further evaluated. The potential target genes of miR-27a-3p were screened through unbiased mRNA-seq and further validated using Western blot and immunohistochemistry in HEK-293T cells and in the brains of mice with epilepsy induced by lithium chloride–pilocarpine. Results We found 82 upregulated and 76 downregulated miRNAs in the plasma from pediatric patients compared with controls (p < 0.01), of which miR-27a-3p exhibited a very low p value (p < 0.0001) and validated in additional plasma samples. Two genes, GOLM1 and LIMK1, whose mRNA levels were decreased (p < 0.001) with the increase of miR-27a-3p were further validated in both HEK-293T cells and in epileptic mice. Conclusions MiR-27a-3p exhibits potential as a diagnostic and therapeutic marker for epilepsy. We postulate that additional studies on the downstream targets of miR-27a-3p will unravel its roles in epileptogenesis or disease progression. Impact A total of 158 differentially expressed miRNAs were detected in plasma between epileptic and control children. Plasma miR-27a-3p was one of the miRNAs with a low p value. GOLM1 and LIMK1 were validated as downstream target genes of miR-27a-3p. miR-27a-3p has potential as a diagnostic and therapeutic marker for epilepsy.

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Early surgical approaches in pediatric epilepsy — a systematic review and meta-analysis

Cited by 3 publications

References 31 publications

Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study

Trends, outcomes, and complications of surgery for lesional epilepsy in infants and toddlers: A multicenter study

A multi‐center comparison of surgical techniques for corpus Callosotomy in pediatric drug‐resistant epilepsy

microRNA profilings identify plasma biomarkers and targets associated with pediatric epilepsy patients

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