Surgical strategies for pediatric epilepsy

Guan, Jian; Karsy, Michael; Ducis, Katrina; Bollo, Robert J.

doi:10.21037/tp.2016.03.02

Cited by 25 publications

(19 citation statements)

References 110 publications

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“…Besides the PubMed search, we included further relevant papers that were cited by the retrieved papers or that were indicated by the PubMed website as "Similar Articles". In total, we identified 25 eligible clinical studies or case (series) reports (Supplementary Table S1) and 7 review papers that specifically refer to LiTT in pediatric patients [4,[11][12][13][14][15][16]. Currently clinical reports on 179 pediatric patients who underwent LiTT for epilepsy surgery are available.…”

Section: Introductionmentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Hoppe

Helmstaedter

2020

Seizure

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Laser interstitial thermotherapy (LiTT) is a novel stereotactic approach to the surgical treatment of severe drugresistant focal epilepsies. This review extends our recent general review on this topic (Hoppe et al. Laser interstitial thermotherapy [LiTT] in epilepsy surgery. Seizure 2017; 48:45-52) with a focus on children (age < 18 years). A PubMed search retrieved 25 uncontrolled case series reports that included a total of 179 pediatric patients as well as 7 review papers that specifically referred to using LiTT in pediatric epilepsy surgery (due August 31, 2018). Hypothalamic hamartomas (HH) represented the most frequent indication (64.2%) while therapeutic evidence for other more frequent etiologies underlying severe focal childhood epilepsies (e.g. focal cortical dysplasia, mesiotemporal sclerosis) is still scarce (n < 20). For the published cases, the rate of severe complications was 3.4% and the overall complication rate was 23.5%. The seizure freedom rate (Engel class 1) was 57.5% (including patients with early follow-up and repeat thermoablations). None of the studies included the systematic evaluation of the cognitive outcome. Overall, the published evidence does not yet allow a scientific or clinical judgement on the utility of LiTT for pediatric epilepsy surgery. LiTT is likely to extend the neurosurgical toolbox with regard to deep brain lesions (e.g. HH). However, in cases that are equally accessible for both approaches therapeutic superiority of LiTT over open resective surgery still remains to be demonstrated. Recommendations for controlled though non-randomized outcome studies are provided.

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Section: Introductionmentioning

confidence: 99%

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Hoppe

Helmstaedter

2020

Seizure

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“…Resective surgery is the preferred treatment for DRE in the pediatric population and the most likely surgical therapy to achieve seizure freedom 7 . The resection extension ranges from simple lesionectomy to single or multiple lobectomies and is based on seizure type, imaging findings, ictal and functional mapping of each patient 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Even so, 20 to 30% of patients continue to have seizures that contribute to increased morbidity and mortality [1][2][3][4][5][6] , characterizing what is called refractory epilepsy. When there is no therapeutic response, many of these patients may have some benefit from neurosurgical treatment, which is founded on the microsurgical resection of the epileptogenic zone, of the epileptogenic lesion or on its isolation with callosotomy or with hemispherectomy [1][2][3][4]7 . The evolution in the presurgical evaluation and in the anesthetic and surgical techniques have led this approach to great success rates [1][2][3][4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…When there is no therapeutic response, many of these patients may have some benefit from neurosurgical treatment, which is founded on the microsurgical resection of the epileptogenic zone, of the epileptogenic lesion or on its isolation with callosotomy or with hemispherectomy [1][2][3][4]7 . The evolution in the presurgical evaluation and in the anesthetic and surgical techniques have led this approach to great success rates [1][2][3][4][5][6][7][8] . However, not all patients are candidates for surgery, especially those with multifocal seizures.…”

Section: Introductionmentioning

confidence: 99%

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Vagus Nerve Stimulation in Patients With Refractory Epilepsy: a case series

Takeshita¹,

Oldoni²,

Tacla³

et al. 2019

jbnc

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Approximately 33% of patients with epilepsy do not respond to treatment with a single antiepileptic drug. Many of these patients can benefit from neurosurgical treatment. However, not all patients are candidates for surgery, and in these cases vagus nerve stimulation (VNS) presents as a good therapeutic option. Objectives: Evaluation of efficiency, tolerability and safety in the control of seizures after VNS implantation in patients from a reference hospital. Methods: cross-sectional study examined 20 patients who underwent implantation of the VNS in our facilities between 2007 and 2014. Proportions and chi-square test were applied (statistical significance level set to p ≤ 0.05). Results: Mean follow-up was 31.3 months. Seizure frequency decreased in 55% of the patients. Among them, 11 patients believed that VNS had improved their quality of life. The mean reduction reported by other patients was 78.3%. More than 30% reported no adverse effects. About 70% of patients no longer required hospitalizations and 95% reported reduction in the number of hospitalizations. Conclusion: In this population, VNS proved to be a good option in the treatment of refractory epilepsy and also in providing a significant improvement in quality of life, (reduction of seizures and hospitalizations), mood, attention and memory, which directly reflects on their social and cognitive.

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“…Accurate localization of the EZ is therefore critical, as is information obtained from semiology, EEG, structural magnetic resonance imaging (MRI), and other advanced testing. [15] Seizures localizable through scalp EEG or MRI are more amenable to surgical cure;[11,12,21] when noninvasive testing fails to localize epileptogenic focus, patients may require intracranial electrode recording. [15]…”

Section: Seegmentioning

confidence: 99%

An update on pediatric surgical epilepsy: Part II

Gadgil

Muir

LoPresti

et al. 2019

Surgical Neurology International

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Background: Recent advances may allow surgical options for pediatric patients with refractory epilepsy not previously deemed surgical candidates. This review outlines major technological developments in the field of pediatric surgical epilepsy. Methods: The literature was comprehensively reviewed and summarized pertaining to stereotactic electroencephalography (sEEG), laser ablation, focused ultrasound (FUS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in pediatric epilepsy patients. Results: sEEG allows improved seizure localization in patients with widespread, bilateral, or deep-seated epileptic foci. Laser ablation may be used for destruction of deep-seated epileptic foci close to eloquent structures; FUS has a similar potential application. RNS is a palliative option for patients with eloquent, multiple, or broad epileptogenic foci. DBS is another palliative approach in children unsuitable for respective surgery. Conclusion: The landscape of pediatric epilepsy is changing due to improved diagnostic and treatment options for patients with refractory seizures. These interventions may improve seizure outcomes and decrease surgical morbidity, though further research is needed to define the appropriate role for each modality.

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Surgical strategies for pediatric epilepsy

Cited by 25 publications

References 110 publications

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery

Vagus Nerve Stimulation in Patients With Refractory Epilepsy: a case series

An update on pediatric surgical epilepsy: Part II

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