Long‐term outcome of resective epilepsy surgery in Norwegian children

Km, Aaberg; As, Eriksson; Ramm‐Pettersen, Jon; Ko, Nakken

doi:10.1111/j.1651-2227.2012.02834.x

Cited by 19 publications

(9 citation statements)

References 14 publications

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“…33 A recent Norwegian retrospective questionnaire study in children with a response rate of 70% reported 58% seizure-free after a mean of 7 years. 23 However, sustained seizure freedom was not reported in these studies.…”

Section: Discussionmentioning

confidence: 89%

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Long-term outcomes of epilepsy surgery in Sweden

et al. 2013

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Objective:To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden.Methods:Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls.Results:In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p < 0.001) and 38% of nonoperated children (not significant). Forty-one percent of operated adults and 44% of operated children had sustained seizure freedom since surgery, compared to none of the controls (p < 0.0005). Multivariate analysis identified ≥30 seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p < 0.0005).Conclusions:This population-based, prospective study shows good long-term seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults.Classification of evidence:This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.

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Section: Discussionmentioning

confidence: 89%

“…A number of studies report cross-sectional long-term follow-up of pediatric epilepsy surgery, with seizure freedom in 50% to 82% of patients 5 to 12 years after TLR. 23–28 Only one study is longitudinal and reports sustained seizure freedom (Engel 1) in 54% of patients 5 years after TLR. 29 …”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of epilepsy surgery in Sweden

et al. 2013

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“…In most series improvement or resolution of epileptic encephalopathy is reflected in improved cognition and behavior, either formally tested or subjectively reported by the patient's family [ 95 ]. Cognitive and behavioral improvements after hemispherectomy have been noted since the onset of the application of the technique to epilepsy [ 96 , 97 ], even being credited for the resolution of Von Monakow's diaschisis [ 98 ].…”

Section: Childhood Syndromesmentioning

confidence: 99%

Surgical Treatment of Pediatric Epileptic Encephalopathies

Fridley

Reddy

Curry

et al. 2013

Epilepsy Research and Treatment

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Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed.

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“…For selected patients, surgery with localization and resection of the epileptogenic lesion is the best alternative to achieve seizure freedom. Among pediatric cohorts, the rate of seizure freedom after surgery ranges from 40 to 82% [6-14]. Surgery is, however, a costly undertaking, and thus economic utility should be investigated.…”

Section: Introductionmentioning

confidence: 99%

An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery

et al. 2020

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Introduction: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy. Methods: We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase ® thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results. Results: Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be costeffective. Conclusion: Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery.

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Long‐term outcome of resective epilepsy surgery in Norwegian children

Abstract: The results of epilepsy surgery in this paediatric cohort are very edifying, and it is our impression that this treatment option is underused in Norway.

Cited by 19 publications

References 14 publications

Long-term outcomes of epilepsy surgery in Sweden

Long-term outcomes of epilepsy surgery in Sweden

Surgical Treatment of Pediatric Epileptic Encephalopathies

An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery

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