Individually tailored extratemporal epilepsy surgery in children: Anatomo-electro-clinical features and outcome predictors in a population of 53 cases

Liava, Alexandra; Francione, Stefano; Tassi, Laura; Russo, Giorgio Lo; Cossu, Massimo; Mai, Roberto; Darra, Francesca; Fontana, Elena; Bernardina, Bernardo Dalla

doi:10.1016/j.yebeh.2012.05.008

Cited by 51 publications

(40 citation statements)

References 38 publications

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“…We observed in the present study that preoperative epilepsy duration of 7 years or less was a significant predictor of postoperative seizure freedom. Other investigators have described a similar relationship between epilepsy duration and seizure outcomes, 41,58 sug gesting that earlier operative therapy may improve the likelihood of Engel Class I outcome. Furthermore, sev eral studies have shown that pediatric patients who at tain seizure control postoperatively may also benefit from improved intellectual and cognitive ability, 42,53 better memory function, 40 decreased medication use and side effects, 32,46 fewer behavioral problems, 45 and overall im proved quality of life 38,40 compared with patients with continued seizures.…”

Section: Discussionmentioning

confidence: 73%

Seizure outcomes after resective surgery for extra–temporal lobe epilepsy in pediatric patients

Englot

Breshears

Sun

et al. 2013

PED

141

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While temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults, seizures in children are more often extratemporal in origin. Extra–temporal lobe epilepsy (ETLE) in pediatric patients is often medically refractory, leading to significantly diminished quality of life. Seizure outcomes after resective surgery for pediatric ETLE vary tremendously in the literature, given diverse patient and epilepsy characteristics and small sample sizes. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after resective surgery for ETLE, excluding hemispherectomy. Thirty-six studies were examined. These 36 studies included 1259 pediatric patients who underwent resective surgery for ETLE. Seizure freedom (Engel Class I outcome) was achieved in 704 (56%) of these 1259 patients postoperatively, and 555 patients (44%) continued to have seizures (Engel Class II–IV outcome). Shorter epilepsy duration (≤ 7 years, the median value in this study) was more predictive of seizure freedom than longer (> 7 years) seizure history (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.07–2.14), suggesting that earlier intervention may be beneficial. Also, lesional epilepsy was associated with better seizure outcomes than nonlesional epilepsy (OR 1.34, 95% CI 1.19–1.49). Other predictors of seizure freedom included an absence of generalized seizures (OR 1.61, 95% CI 1.18–2.35) and localizing ictal electroencephalographic findings (OR 1.55, 95% CI 1.24–1.93). In conclusion, seizure outcomes after resective surgery for pediatric ETLE are less favorable than those associated with temporal lobectomy, but seizure freedom may be more common with earlier intervention and lesional epilepsy etiology. Children with continued debilitating seizures despite failure of multiple medication trials should be referred to a comprehensive pediatric epilepsy center for further medical and surgical evaluation.

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Section: Discussionmentioning

confidence: 73%

Seizure outcomes after resective surgery for extra–temporal lobe epilepsy in pediatric patients

Englot

Breshears

Sun

et al. 2013

PED

141

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“…APOS occurred in 29% of patients and were associated with worse outcome. In addition, Liava et al (2012) studied 52 children who received ET epilepsy surgery and were followed up for at least 18 months (mean follow-up time 3.7 years). The proportion of seizure-free patients was 75% after 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, APOS were consistently found to be associated with seizure recurrence (Garcia et al, 1991;Malla et al, 1998;Park et al, 2002;Radhakrishnan et al, 2003;Mcintosh et al, 2005;Jayalakshmi et al, 2011), especially when they were semiologically similar to the patient's habitual seizures (Falconer and Serafetinides, 1963;Bengzon et al, 1968;Garcia et al, 1991;Malla et al, 1998;Park et al, 2002). By contrast, the few studies investigating APOS after ET epilepsy surgery yielded inconsistent results (Tigaran et al, 2003;Mani et al, 2006;Jeha et al, 2007;Jehi et al, 2009;Liava et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of acute postoperative seizures in extra-temporal lobe epilepsy surgery

Gennaro¹,

D’Aniello²,

Risi³

et al. 2013

Clinical Neurophysiology

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“…Family surveys have also demonstrated higher levels of education, independence, employment status, and overall satisfaction associated with seizure freedom in pediatric patients (Keene et al, 1998a, b). Also, shorter epilepsy duration has been associated with increased likelihood of postoperative seizure freedom in pediatric epilepsy surgery (Wu et al, 2010;Liava et al, 2012;Englot et al, 2013). These data suggest that early operative intervention may lead to improved neurocognitive and seizure outcomes, and thus should be strongly considered in pediatric tumoral epilepsy, even in cases with a presumed benign slow-growing lesion, if seizures are medically refractory.…”

Section: Surgical Considerations In Pediatric Patientsmentioning

confidence: 96%

Epilepsy and Brain Tumors

Newton

Maschio²,

Pritikin³

2015

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Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20-50% of patients with meningioma and 20-35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60-90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.

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Individually tailored extratemporal epilepsy surgery in children: Anatomo-electro-clinical features and outcome predictors in a population of 53 cases

Cited by 51 publications

References 38 publications

Seizure outcomes after resective surgery for extra–temporal lobe epilepsy in pediatric patients

Seizure outcomes after resective surgery for extra–temporal lobe epilepsy in pediatric patients

Prognostic significance of acute postoperative seizures in extra-temporal lobe epilepsy surgery

Epilepsy and Brain Tumors

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