Epilepsy surgery in children with drug-resistant epilepsy, a long-term follow-up

Hallböök, Tove; Tideman, Pontus; Rosén, Ingmar; Lundgren, Johan; Tideman, Eva

doi:10.1111/ane.12154

Cited by 31 publications

(32 citation statements)

References 33 publications

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“…Seizure‐free outcome has been reported to decline with longer follow‐up . However, our seizure‐free outcome of 69% was within the range reported in the literature (49–84%), allowing for differences in patient characteristics, case complexities, and surgical practice …”

Section: Discussionsupporting

confidence: 60%

Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome

et al. 2015

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SUMMARYObjective: Since 2008, we have changed our presurgical diagnostic imaging evaluation for medically refractory focal epilepsy to include high-resolution epilepsy protocol on 3 T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) in selected patients with normal or subtle changes on MRI or discordant diagnostic tests. The aim of this study was to evaluate the effectiveness of the change in imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy surgery center. Methods: The change in practice occurred in early 2008, and patients were classified based on old or new practice. The patient characteristics, surgical variables, and seizure-free surgical outcome were compared, and the trend in seizure-free outcome over time was assessed. Results: There was a trend for increased abnormal MRI (92% vs. 86%, respectively, p = 0.062), and increased utilization of FDG-PET (34% vs. 3% respectively, p < 0.001) with new relative to old practice. There were no statistically significant differences in invasive monitoring, location, and type of surgery and histology between the two periods (all p > 0.05). During the old practice, there was no statistically significant change in yearly trend of seizure-free outcome (odds ratio [OR] 0.960, 95% confidence interval [CI] 0.875-1.053, p = 0.386). The change in practice in 2008 was associated with a significant improvement in seizure-free outcome (OR 1.535, 95% CI 1.100-2.142, p = 0.012). During the new practice, there was a significant positive trend in yearly seizure-free outcome (OR 1.219, 95% CI 1.053-1.411, p = 0.008), after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography, and FDG-PET. Significance: We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome. KEY WORDS: Seizure-free outcome, Magnetic resonance imaging, 18-Fluorodeoxyglucose-positron emission tomography, Magnetoencephalography.In children with medically refractory focal epilepsy, surgery has the potential to render these patients seizure-free. Meta-analysis of pediatric epilepsy surgery outcome has shown that for combined temporal and extratemporal lobe epilepsy surgery, seizure-free outcome was 59% and for temporal lobe epilepsy surgery, seizure-free outcome was 62%. 1 We have previously shown that pediatric epilepsy surgery is a cost-effective treatment in the management of children with intractable epilepsy relative to medical therapy.2 As part of the presurgical diagnostic evaluation, the

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Section: Discussionsupporting

confidence: 60%

Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome

et al. 2015

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“…In contrast to previous studies, IQ change in this cohort was not significantly influenced by postsurgical cessation of seizures or AED treatment . The more limited postsurgical use of topiramate in the current sample may account for differences in relation to other cohorts (eg, Skirrow et al).…”

Section: Discussioncontrasting

confidence: 95%

“…Researchers have speculated that eliminating the effects of seizures and AEDs from the developing brain may reduce maturational disturbances in functional cortical networks, playing a critical part in postsurgical improvement . The current research supports this hypothesis and extends previous findings to a much broader group, including children with extratemporal surgery and a variety of pathologies.…”

Section: Discussionsupporting

confidence: 83%

Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study

et al. 2019

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Summary Objective Intelligence quotient (IQ) outcomes after pediatric epilepsy surgery show significant individual variation. Clinical factors such as seizure cessation or antiepileptic medication discontinuation have been implicated, but do not fully account for the heterogeneity seen. Less is known about the impact of neurobiological factors, such as brain development and resection location. This study examines clinical and neuroimaging factors associated with cognitive outcome after epilepsy surgery in childhood. Methods Fifty‐two children (28 boys, 24 girls) were evaluated for epilepsy surgery and reassessed on average 7.7 years later. In the intervening time, 13 were treated pharmacologically and 39 underwent focal surgery (17 temporal, 16 extratemporal, six multilobar; mean age at surgery = 14.0 years). Pre‐ and postsurgical assessments included IQ tests and T1‐weighted brain images. Predictors of IQ change were investigated, including voxel‐based analyses of resection location, and gray and white matter volume change. Results Overall modest IQ improvement was seen in children treated surgically, but not in those treated pharmacologically only. Applying a ≥10‐point change threshold, 39% of the surgically treated children improved, whereas 10% declined. Clinical factors associated with IQ increases were lower preoperative IQ and longer follow‐up duration, whereas seizure and antiepileptic medication cessation were not predictive. Among neuroimaging factors, we observed that left anterior temporal resections impacted negatively on verbal reasoning, linked to full‐scale IQ decline. In contrast, gray matter volume change in ipsi‐ and contralesional hemispheres was positively correlated with IQ change. Voxel‐based morphometry identified the gray matter volume change in the contralesional dorsolateral frontal cortex as most strongly associated with IQ improvement. Significance We show that a variety of factors are likely to contribute to patterns of postsurgical change in IQ. Neuroimaging results indicate that left anterior temporal resections constrain development of verbal cognition, whereas simultaneously cortical growth after surgical treatment can support improvements in IQ.

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“…In contrast with our findings, Hallbook et al . () found that among 33 surgical patients, those who were seizure free had higher PSI scores at LTF, with no significant differences in FSIQ, PRI, VCI, and WMI.…”

Section: Discussionmentioning

confidence: 98%

Development of intelligence 4 to 11 years after paediatric epilepsy surgery

Puka

Tavares

Smith

2015

Journal of Neuropsychology

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Epilepsy surgery in children with drug-resistant epilepsy, a long-term follow-up

Cited by 31 publications

References 33 publications

Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome

Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome

Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study

Development of intelligence 4 to 11 years after paediatric epilepsy surgery

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