Treatment of Infantile Spasms: Medical or Surgical?

Shields, W. Donald; Shewmon, D. Alan; Chugani, Harry T.; Peacock, Warwick J.

doi:10.1111/j.1528-1157.1992.tb06224.x

Cited by 53 publications

(20 citation statements)

References 27 publications

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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

169

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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Section: Methodsmentioning

confidence: 87%

Improved outcomes in pediatric epilepsy surgery

Hemb¹,

Velasco²,

Parnes³

et al. 2010

Neurology

169

161

View full text Add to dashboard Cite

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“…Estimates of the incidence of epilepsy past the neonatal period range from 0% to 46% for neonatal AIS 20,25,27,29,43 and 6% to 41% for neonatal CVST. 4,32,49 A small portion of perinatal stroke patients undergo surgery because of severe epilepsy syndromes such as infantile spasms 50 or intractable epilepsy. 51 Outcome There are few studies of stroke recurrence risk after neonatal stroke.…”

Section: Residual Effects Of Perinatal Strokementioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

878

377

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Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

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“…Neuroimaging studies included high-resolution magnetic resonance imaging (MRI) and '*fluoro-2-deoxyg1ucose (FDG) positron emission tomography (PET) (9, 46,47). This protocol presumes that behavioral seizures may appear generalized or nonlocalizing in very young children, but that the epileptogenic focus can be attributed to focal and/or unilateral zone(s) of cortical abnormality (ZCA) (44). As such, the epileptogenic region for surgical resection can be anatomically defined based on subtle clinical signs, EEG characteristics, and neuroimaging data showing convergent localizable information.…”

Section: Patient Evaluationmentioning

confidence: 99%

Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997

et al. 1999

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Summary:Purpose: Young children with refractory symptomatic epilepsy are at risk for developing neurologic and cognitive disabilities. Stopping the seizures may prevent these disabilities, but it is unclear whether resective surgery is associated with adequate long-term seizure control.Methods: This study determined pre-and postsurgery seizure frequency and antiepileptic drug (AED) use (6 months to 10 years) in children with symptomatic seizures from unilateral cortical dysplasia (CD; n = 64) and non-CD etiologies (i.e., ischemia, infection; n = 71), and compared them with older temporal lobe epilepsy (TLE; n = 31) patients with complex partial seizures.Results: Compared with presurgery, postsurgery seizure frequencies were decreased for CD, non-CD, and TLE patients (p < 0.002), and there were no differences between the three groups from 6 to 24 months after surgery (p > 0.12). At 5 years after surgery, seizure frequencies were greater in CD compared with TLE cases (p = 0.009). Compared with presurgery, the number of AEDs declined after surgery in all three groups (p < 0.002), and positively correlated with seizure frequencies (p = Conclusions: This study indicates that seizure relief and AED use after resective surgery for symptomatic CD and non-CD etiologies was comparable with complex partial TLE cases up to 2 years after surgery. Furthermore, at 5 years after surgery, CD patients had outcomes better than those before surgery, but worse than TLE cases. In young children, these findings support the concept that early removal of symptomatic pathologic substrates is associated with seizure control and reduced AED use, similar to that noted in older TLE cases up to 2 years after surgery. Seizure control may reduce the risk of developing the seizure-related encephalopathy associated with severe symptomatic early-onset childhood epilepsy.

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Treatment of Infantile Spasms: Medical or Surgical?

Cited by 53 publications

References 27 publications

Improved outcomes in pediatric epilepsy surgery

Improved outcomes in pediatric epilepsy surgery

Management of Stroke in Infants and Children

Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997

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