Surgery of epilepsy associated with focal lesions in childhood

Bourgeois, Marie; Sainte‐Rose, Christian; Lellouch‐Tubiana, Arielle; Malucci, Conor; Brunelle, Françis; Maixner, Wirginia; Cinalli, Giuseppe; Pierre-Kahn, Alain; Rénier, Dominique; Zérah, Michel; Hirsch, J F; Goutières, Françoise; Aicardi, Jean

doi:10.3171/jns.1999.90.5.0833

Cited by 90 publications

(37 citation statements)

References 69 publications

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“…1). This suggestion is in agreement with findings in several studies in intellectually unselected groups of patients (48)(49)(50)(51)(52). However, some studies failed to find a relation between duration of epilepsy and outcome (53)(54)(55)(56).…”

Section: Discussionsupporting

confidence: 92%

Resective Surgery for Intractable Focal Epilepsy in Patients with Low IQ: Predictors for Seizure Control and Outcome with Respect to Seizures and Neuropsychological and Psychosocial Functioning

et al. 2004

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Summary:Purpose: To investigate possible predictive factors for seizure control in a group of children and adults with low IQs (IQ, ≤70) who underwent resective surgery for intractable focal epilepsy and to study outcome with respect to seizures and neuropsychological functioning. We also studied psychosocial outcome in the adult patients.Methods: Thirty-one patients (eight children younger than 18 years) with a Wechsler Full Scale IQ of 70 or less underwent comprehensive neuropsychological assessments before and 2 years after surgery. Adults also completed the Washington Psychosocial Seizure Inventory (WPSI). Univariate analyses were used to identify variables differentiating between patients who became seizure free and those who did not. Pre-and postoperative test results were compared by t test for dependent samples.Results: Forty-eight percent of the patients became seizure free, 52% of those with temporal lobe resection and 38% of those with extratemporal resection. Only one variable was predictive for seizure outcome: duration of epilepsy. In one third of the patients, who had the shortest duration of epilepsy (<12 years), 80% became seizure free. Significant improvement was seen regarding vocational adjustment in adults (WPSI). Seizure-free adults improved their Full Scale IQ scores. No cognitive changes were found in seizure-free children or in patients who did not become seizure free. Conclusions: A good seizure outcome was obtained after resective surgery in patients with intractable focal epilepsy and low IQ, provided that treatment was done relatively shortly after onset of epilepsy. No adverse effects were seen on cognitive and psychosocial functioning.

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Section: Discussionsupporting

confidence: 92%

Resective Surgery for Intractable Focal Epilepsy in Patients with Low IQ: Predictors for Seizure Control and Outcome with Respect to Seizures and Neuropsychological and Psychosocial Functioning

et al. 2004

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“…There have been no studies looking at a series of children with symptomatic epilepsy. Children with lesional epilepsy are at a larger risk to become refractory to medication (Bourgeois et al, 1999) and many of them could benefit from a better understanding of their epileptic generators.…”

Section: Discussionmentioning

confidence: 99%

“…It is a noninvasive technique that can be applied to children with epilepsy and might reveal additional information on the developmental changes of this disease. Children with symptomatic epilepsy are more likely to develop refractory seizures and often need repeated MRI scans (Bourgeois et al, 1999). Therefore, children with underlying structural lesions are a preferred group to evaluate the use of EEG-fMRI in young epilepsy patients.…”

mentioning

confidence: 99%

Hemodynamic Responses to Interictal Epileptiform Discharges in Children with Symptomatic Epilepsy

et al. 2007

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SUMMARYPurpose: Simultaneous electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) (EEG-fMRI) recording is a noninvasive tool for investigating epileptogenic networks. Most EEG-fMRI studies in epilepsy have been performed in adults. Childhood epilepsies, however, differ from those in adults due to interactions between epileptogenic and developmental processes. The purpose of this study was to investigate EEG-fMRI in children with lesional epilepsies. Methods: Thirteen children with symptomatic epilepsy underwent a 20-min EEG-fMRI acquisition at 3 T under sedation-induced sleep. Statistical analysis was performed using the timing of spikes as events, modelled with hemodynamic response functions (HRFs) that peaked at 3, 5, 7, and 9 s after the spike. Results: Each spike type was analyzed separately, resulting in 25 studies. In 84% of the studies, blood oxygenation level-dependent (BOLD) responses were localized in the lesion or brain area presumably generating spikes. Activation (positive BOLD) corresponding with the lesion was seen in 20% and deactivation (negative BOLD) in 52% of the studies. In the area of spike generation, activation was found in 48% of studies and deactivation in 36%. Conclusions: Despite the necessarily short recording times (20 min), good results could be obtained from the EEG-fMRI recordings, performed in sedated children using a high field scanner and individual HRFs. In contrast to studies in adults, deactivations in the lesion and the irritative zone were more common than activations. The impact of age, sleep, and sedation on the BOLD response might explain these findings, but future studies in children should not disregard the importance of deactivations in relation to the epileptogenic network. KEY WORDS:EEG-fMRI-Spike-Negative BOLD-Polymicrogyria.Childhood epilepsies differ from adult epilepsies regarding etiology, pathogenesis, electroclinical findings (e.g., electroencephalographic-EEG-patterns, seizure presentation), and prognosis. Epileptic activity patterns change during the children's development due to the difference in mechanisms of epileptogenesis in the immature brain as compared to the mature brain (Holmes et al., 1997). The immature brain is more prone to develop

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“…Some series have demonstrated improvement in development, but this is not universally seen. Bourgeois et al [102]found that some patients with seizure control after epilepsy surgery showed improvements in behavior (31%) and in cognition (25%). Multivariate analysis showed that cognitive function correlated highly with the duration of epilepsy prior to surgery and that behavioral disorders correlated with seizure frequency.…”

Section: Are the Goals Outcome Measures And Follow-up Well Defined?mentioning

confidence: 99%

Selection and Evaluation of Children for Epilepsy Surgery

Nordli

Kelley

2001

Pediatr Neurosurg

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Major determinants of the success of epilepsy surgery are the proper selection and evaluation of the patient. Candidates should have medically intractable, disabling epilepsy. The evaluation requires a unified, systematic approach by a comprehensive team of health professionals. Key points, common to most evaluations, are enumerated and provide a useful tool for mental organization. In general, the greater the degree of congruent information derived from these investigations, the better the candidacy for surgery. After this, completeness of resection and etiology are other important predictors of success. Children present unique challenges and opportunities owing to the vulnerability and plasticity of the developing nervous system. Surgery for intractable epilepsy can be a rewarding therapy, and in select children, the only chance for cure and substantial development progress.

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Surgery of epilepsy associated with focal lesions in childhood

Abstract: These data must be taken into account when selecting patients for surgical treatment and when deciding the timing of surgery. Early surgical intervention allows for optimum brain development.

Cited by 90 publications

References 69 publications

Resective Surgery for Intractable Focal Epilepsy in Patients with Low IQ: Predictors for Seizure Control and Outcome with Respect to Seizures and Neuropsychological and Psychosocial Functioning

Resective Surgery for Intractable Focal Epilepsy in Patients with Low IQ: Predictors for Seizure Control and Outcome with Respect to Seizures and Neuropsychological and Psychosocial Functioning

Hemodynamic Responses to Interictal Epileptiform Discharges in Children with Symptomatic Epilepsy

Selection and Evaluation of Children for Epilepsy Surgery

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