Temporal and Extended Temporal Resections for the Treatment of Intractable Seizures in Early Childhood

Pd, Adelson; Wj, Peacock; Ht, Chugani; Yg, Comair; Hv, Vinters; Wd, Shields; Da, Shewmon

doi:10.1159/000120659

Cited by 73 publications

(38 citation statements)

References 20 publications

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“…His review demonstrated that 60% of patients are seizure free following surgery while an additional 18% are improved. These results are comparable to those found in adult epilepsy series [2, 3, 5, 6, 7, 8]. In addition, his review reports that CT and MRI are capable of identifying the epileptogenic area in 62–100% of patients.…”

Section: Introductionsupporting

confidence: 80%

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Pathology and Neuroimaging in Pediatric Temporal Lobectomy for Intractable Epilepsy

et al. 2001

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Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988–1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. Results: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64%), while CT scan was found to be abnormal in only 12/39 (31%). Surgical outcome was excellent, with 34/42 patients (80%) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7%) had little improvement (Engel class III) and 4 (10%) were unchanged (Engel class IV). Three patients (7%) had surgical complications. Conclusions: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.

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Section: Introductionsupporting

confidence: 80%

“…Mesial temporal sclerosis (MTS) is the most common pathological finding and is reported in 65% of the adult series [2, 3]. Blume [4]has recently reviewed 11 papers reporting on the outcome from temporal lobectomy in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Pathology and Neuroimaging in Pediatric Temporal Lobectomy for Intractable Epilepsy

et al. 2001

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“…This is a different approach than targeting areas of EEG ictal onsets for resection. 31,32 Our study from a single center achieved high reporting rates for seizure outcome. However, the reader should note that our series has a higher proportion of younger patients, more cases of hemispherectomy, and fewer cases of temporal lobe resections compared with other cohorts from pediatric epilepsy surgery centers.…”

Section: Methodsmentioning

confidence: 87%

Improved outcomes in pediatric epilepsy surgery

Hemb¹,

Velasco²,

Parnes³

et al. 2010

Neurology

170

161

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Objective: Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time. Methods:Pediatric epilepsy surgery patients operated in the first 11 years (1986 -1997; pre-1997) were compared with the second 11 years (1998 -2008; post-1997) for differences in presurgical and postsurgical variables.Results: Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, ϩ16%), 1 (81%, ϩ18%), 2 (77%, ϩ19%), and 5 (74%, ϩ29%) years, and more seizure-free patients were on medications at 0.5 (97%, ϩ6%), 1 (88%, ϩ9%), and 2 (76%, ϩ29%), but not 5 (64%, ϩ8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery. Conclusions: Improved technology and surgical procedures along with changes in clinical practicewere likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients. Neurology Surgery for children with refractory epilepsy has become an important treatment option over the past 30 years. Initially, most patients were adolescents with focal lesions involving the temporal lobe similar to adult epilepsy surgery.1,2 With modern neuroimaging (e.g., MRI SPECT and fluorodeoxyglucose [FDG]-PET), the number of surgical centers expanded, as did etiologies and types of operations. Today, pediatric epilepsy surgery has evolved to include extratemporal operations and cerebral hemispherectomy for children of all ages. Etiologies range from cortical dysplasia, tumors, and perinatal strokes to rarer syndromes such as hemimegalencephaly, tuberous sclerosis complex (TSC), Rasmussen encephalitis, Sturge-Weber syndrome, and hypothalamic hamartomas.3 Many children are treated because they are at risk for epileptic encephalopathies. e-Pub ahead of print on April 28, 2010, at www.neurology.org. From the Departments of Neurosurgery (M.H., T.R.V., G.W.M.) and Neurology (H

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“…In drug resistant cases neurosurgery is considered effective (Branch and Dyken, 1979, Dolman et al, 1981, Mimaki et al, 1983, Ruggieri et al, 1989, Uthman et al, 1991, Wyllie et al, 1996a, Chugani et al, 1993, Adelson et al, 1992, Hoffman, 2002). …”

Section: Managementmentioning

confidence: 99%

Neuronal Networks in West Syndrome as Revealed by Source Analysis and Renormalized Partial Directed Coherence

et al. 2012

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Temporal and Extended Temporal Resections for the Treatment of Intractable Seizures in Early Childhood

Cited by 73 publications

References 20 publications

Pathology and Neuroimaging in Pediatric Temporal Lobectomy for Intractable Epilepsy

Pathology and Neuroimaging in Pediatric Temporal Lobectomy for Intractable Epilepsy

Improved outcomes in pediatric epilepsy surgery

Neuronal Networks in West Syndrome as Revealed by Source Analysis and Renormalized Partial Directed Coherence

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