Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children

Moosa, Ahsan N.V.; Gupta, Ajay; Jehi, Lara; Marashly, Ahmad; Cosmo, G. Di; Lachhwani, Deepak; Wyllie, Elaine; Kotagal, Prakash; Bingaman, William

doi:10.1212/wnl.0b013e31827dead9

Cited by 163 publications

(180 citation statements)

References 22 publications

(39 reference statements)

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“…The overall rate of seizure freedom was 73.4%, which is slightly higher than the rate of seizure freedom found by Holthausen et al 15 and comparable to other large, more recent series. 6,9,19,25,27,32,43 Long-term sustainability of seizure freedom is absolutely critical to justify surgery for epilepsy, which is (7) 10 (71) 2 (14) Sugimoto et al, 1999 1991-1996 Hospital for Sick Children Epilepsia (14) 33 (30) 51 (46) (continued) (27) 16 (33) 8 ( (44) 20 (21) 19 ( (42) 63 (34) 28 ( an irreversible intervention. Long-term seizure-free rates (≥ 5 years) following surgery for temporal lobe epilepsy are comparable to those reported in shorter-term studies.…”

Section: Discussionmentioning

confidence: 99%

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Griessenauer

Salam

Hendrix

et al. 2015

PED

137

112

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OBJECT Evidence in support of hemispherectomy stems from a multitude of retrospective studies illustrating individual institutions' experience. A systematic review of this topic, however, is lacking in the literature. METHODS A systematic review of hemispherectomy for the treatment of refractory epilepsy available up to October 2013 was performed using the following inclusion criteria: reports of a total of 10 or more patients in the pediatric age group (≤ 20 years) undergoing hemispherectomy, seizure outcome reported after a minimum follow-up of 1 year after the initial procedure, and description of the type of hemispherectomy. Only the most recent paper from institutions that published multiple papers with overlapping study periods was included. Two reviewers independently applied the inclusion criteria and extracted all the data. RESULTS Twenty-nine studies with a total of 1161 patients met the inclusion criteria. Seizure outcome was available for 1102 patients, and the overall rate of seizure freedom at the last follow-up was 73.4%. Sixteen studies (55.2%) exclusively reported seizure outcomes of a single type of hemispherectomy. There was no statistically significant difference in seizure outcome and type of hemispherectomy (p = 0.737). Underlying etiology was reported for 85.4% of patients with documented seizure outcome, and the overall distribution of acquired, developmental, and progressive etiologies was 30.5%, 40.7%, and 28.8%, respectively. Acquired and progressive etiologies were associated with significantly higher seizure-free rates than developmental etiologies (p < 0.001). Twenty of the 29 studies (69%) reported complications. The overall rate of hydrocephalus requiring CSF diversion was 14%. Mortality within 30 days was 2.2% and was not statistically different between types of hemispherectomy (p = 0.787). CONCLUSIONS Hemispherectomy is highly effective for treating refractory epilepsy in the pediatric age group, particularly for acquired and progressive etiologies. While the type of hemispherectomy does not have any influence on seizure outcome, hemispherotomy procedures are associated with a more favorable complication profile.

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Section: Discussionmentioning

confidence: 99%

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Griessenauer

Salam

Hendrix

et al. 2015

PED

137

112

View full text Add to dashboard Cite

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“…A recent review 35 of large modern studies revealed overall Engel Class I outcomes in 541 (78.9%) of 686 patients who had undergone surgery for this condition. Resection is, in general, somewhat more successful than other epilepsy operations, such as hemispherectomy 25 for Rasmussen encephalitis (about 70% Engel Class I), SturgeWeber syndrome (same), or hemimegalencephaly (approximately 50% Engel Class I). Palliative epilepsy interventions, such as vagus nerve stimulator placement or corpus callosotomy, are less likely to result in seizure freedom.…”

Section: Nononcological Perspectivementioning

confidence: 98%

Seizure control after subtotal lesional resection

Gump

Skjei

Karkare

2013

FOC

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Reports on seizure outcomes following surgery for lesional epilepsy consistently cite extent of resection as a significant predictor of outcome. Unfortunately, gross-total resection is not technically feasible in all cases of medically refractory tumor-associated epilepsy. Here, the authors present the case of a 4-year-old girl whose epilepsy was medically controlled after 1-stage electrocorticography-guided subtotal resection (STR) of a large diffuse protoplasmic astrocytoma. They also review the modern literature on epilepsy associated with brain tumors. Outcomes are compared with those following surgical treatment of focal cortical dysplasia and vascular lesions. Gross-total lesional resection shows significant superiority across pathologies and anatomical regions. Despite a considerable number of STRs yielding seizure freedom, other favorable treatment factors have not been defined. Although gross-total lesional resection, if possible, is clearly superior, tailored surgery may still offer patients a significant opportunity for a good outcome. Treatment factors yielding successful seizure control following STR remain to be fully elucidated.

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“…A longitudinal study of 170 patients looking into long-term prognosis after hemispherectomy reported that hypometabolic abnormalities on [18F]FDG-PET may be a more reliable marker of potential independent epileptogenesis in the contralateral hemisphere than the structural abnormalities seen on brain MRI [105].…”

Section: Pet [18f]fdg-petmentioning

confidence: 99%

Neuroimaging the Epileptogenic Process

et al. 2014

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Epilepsy is one of the most common chronic neurological conditions worldwide. Anti-epileptic drugs (AEDs) can suppress seizures, but do not affect the underlying epileptic state, and many epilepsy patients are unable to attain seizure control with AEDs. To cure or prevent epilepsy, disease-modifying interventions that inhibit or reverse the disease process of epileptogenesis must be developed. A major limitation in the development and implementation of such an intervention is the current poor understanding, and the lack of reliable biomarkers, of the epileptogenic process. Neuroimaging represents a non-invasive medical and research tool with the ability to identify early pathophysiological changes involved in epileptogenesis, monitor disease progression, and assess the effectiveness of possible therapies. Here we will provide an overview of studies conducted in animal models and in patients with epilepsy that have utilized various neuroimaging modalities to investigate epileptogenesis.

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Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children

Abstract: The long-term seizure-free rates after hemispherectomy remained stable at 63% at 5 years and beyond. This study will assist in better candidate selection for hemispherectomy, presurgical counseling, and early identification of surgical failures.

Cited by 163 publications

References 22 publications

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review

Seizure control after subtotal lesional resection

Neuroimaging the Epileptogenic Process

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