Seizure outcomes in children with epilepsy after resective brain surgery

Lakshmi Nagarajan; Michael Lee; Linda Palumbo; Sharon Lee; Snehal Shah; Peter Walsh; Patricia Cannell; Soumya Ghosh

doi:10.1016/j.ejpn.2015.05.006

Seizure outcomes in children with epilepsy after resective brain surgery

Eur J Paediatr Neurol. 2015 Sep;19(5):577-83. doi: 10.1016/j.ejpn.2015.05.006. Epub 2015 Jun 12.

Authors

Lakshmi Nagarajan¹, Michael Lee², Linda Palumbo³, Sharon Lee⁴, Snehal Shah⁵, Peter Walsh⁶, Patricia Cannell⁷, Soumya Ghosh⁸

Affiliations

¹ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
² Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
³ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
⁴ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
⁵ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
⁶ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
⁷ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].
⁸ Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia. Electronic address: [email protected].

PMID: 26095098
DOI: 10.1016/j.ejpn.2015.05.006

Abstract

Purpose: To assess the role of resective brain surgery in childhood epilepsy.

Methodology: We retrospectively analysed the seizure outcomes in 55 children with epilepsy who had resective brain surgery between 1997 and 2012, at our centre. The children were 1.5-18 years at the time of surgery; their seizure onset was between 0.2 andto 15 years of age. 48 had refractory epilepsy. One child died of tumour progression. Follow-up duration in the survivors ranged from 2 to -16 years (mean: 9).Presurgical evaluation included clinical profiles, non-invasive V-EEG monitoring, neuroimaging with MRIs in all; SPECT and PET in selected patients. 54 had intraoperative ECoG.

Results: An Engel Class 1 outcome was seen in 78% of the cohort, with 67% being off all AEDs at the most recent follow-up. Children with tumours constituted the majority (56%), with 87% of this group showing a Class 1 outcome and 84% being off AEDs. Children with cortical dysplasia had a Class 1 outcome in 56%.

Conclusion: Resective brain surgery is an efficacious option in some children with epilepsy. We found ECoG useful to tailor the cortical resection and in our opinion ECoG contributed to the good seizure outcomes.

Keywords: AED withdrawal; Brain tumours; Children; ECoG; Epilepsy surgery; Refractory epilepsy.

MeSH terms

Adolescent
Child
Child, Preschool
Electroencephalography / methods*
Epilepsy / complications
Epilepsy / surgery*
Female
Humans
Infant
Magnetic Resonance Imaging
Male
Neuroimaging / methods
Neurosurgical Procedures / methods*
Retrospective Studies
Seizures / etiology*
Seizures / prevention & control*
Tomography, Emission-Computed, Single-Photon
Treatment Outcome