Seizure outcome after extratemporal epilepsy surgery in childhood

Abstract

FCD Focal cortical dysplasiaAIM The aim of the study was to describe seizure outcome following surgery for focal extratemporal epilepsy and identify factors associated with prolonged postsurgical freedom from seizures.METHOD In this retrospective cohort study, children with drug-resistant focal extratemporal epilepsy were treated surgically and followed up in a single tertiary care centre between 1997 and 2008.RESULTS Eighty children were identified for inclusion in the study (42 males, 38 females; median age 9y 1mo, range 3mo-18y 7mo). The aetiology was identified as focal cortical dysplasia (n=37), low-grade tumour (n=22), tuberous sclerosis (n=9), or non-specific (n=12). Children were followed for a median of 3 years 1 month (range 8mo-10y 7mo) after surgery. Overall, at last follow-up, 50% of the children had been completely seizure free since surgery (Engel class Ia); of these 40 individuals, 15 had discontinued all antiepileptic drugs. Several presurgical factors were associated with a favourable outcome. However, after controlling for confounding factors, aetiology appeared to be the only determinant of long-term seizure outcome as non-specific lesion pathology was associated with seizure recurrence (hazard ratio 10.43; 95% confidence interval 3.26-33.39).INTERPRETATION In 50% of cases, children with surgically treated drug-resistant extratemporal epilepsies have an excellent long-term outcome. The aetiology of the epileptogenic lesion appears to be the only significant determinant of surgical outcome in this population of children. It is difficult to correctly identify non-specific pathology on presurgical magnetic resonance imaging.About 20% of surgical procedures for drug-resistant epilepsy in childhood involve focal resection of areas outside the temporal lobe.1 Although surgical resection for an extratemporal focus is less likely to achieve seizure freedom than temporal lobe resections, improved presurgical diagnostics and patient selection in the last decades appear to have improved the selection and seizure outcome of focal extratemporal resections, as reported in recent case series.2,3 Forty to 70% of children with extratemporal epilepsies could become seizure free after surgery, and this would have a significant impact on the quality of life for these children, especially considering that remission from epilepsy is unlikely to be achieved by medications alone.4,5 However, current literature is limited and only a few, small descriptive series have been published, in which the outcomes and populations were inconsistent and follow-up was mostly short term. [6][7][8] Our purpose was to study a large surgical population of children with focal extratemporal epilepsies, to describe their seizure outcome, and to identify which factors were independently associated with long-term postsurgical seizure freedom. METHOD ParticipantsAll children who had undergone focal resection for drug-resistant epilepsy involving the frontal, parietal, or occipital cortices, confined to one lobe, at Great Ormond Street Hosp...

Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy

“…There was a significant decrease in the amount of anticonvulsants required at time of last follow-up when compared to preoperative use. This reduction in anticonvulsant use agrees with findings of previous studies documenting decreased medication burden after epilepsy surgery [21,29]. Post-surgically, ten (40 %) of our patients were not on an anticonvulsant at the time of last follow-up.…”

Novel surface features for automated detection of focal cortical dysplasias in paediatric epilepsy

“…Surgical resection can result in reduced need for anti-epileptic medication, reduced frequency or most commonly complete absence of seizures (Cross, 2002, D'Argenzio et al, 2011, D'Argenzio et al, 2012) There is evidence too that it can even improve developmental outcome (Skirrow et al, 2011, Skirrow et al, 2015). The challenge in many cases is to accurately locate the area of responsible tissue.…”

Surgery for drug-resistant focal epilepsy

“…[1112] Frontal lobe epilepsy surgery is the second most frequent type of epilepsy surgery, but the results are generally not as good as those after ATL. [131415] Parietal and occipital seizures have been investigated relatively less. [1617] The most prominent clinical manifestations are elementary sensory phenomena at the beginning of seizures in parietal epilepsy and elementary visual hallucinations in occipital epilepsy.…”