Differences in pediatric and adult epilepsy surgery: A comparison at one center from 1990 to 2014

Cloppenborg, Thomas; May, Theodor W.; Blümcke, Ingmar; Fauser, Susanne; Grewe, Philip; Hopf, Johanna L.; Kalbhenn, Thilo; Polster, Tilman; Schulz, Reinhard; Woermann, Friedrich G.; Bien, Christian G.

doi:10.1111/epi.14627

Cited by 35 publications

(37 citation statements)

References 48 publications

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“…The significant decrease in TL surgeries from 2008 to 2015 demonstrated by univariate and multivariate analyses is in line with previous studies in adults and children . Improved management of complex febrile seizures and febrile status epilepticus and the lower incidence or improved treatment of brain infections have been considered possible explanations for reduced anteromesial temporal surgeries .…”

Section: Discussionsupporting

confidence: 86%

“…The significant decrease in TL surgeries from 2008 to 2015 demonstrated by univariate and multivariate analyses is in line with previous studies in adults 1,2,9 and children. 6,10,14 Improved management of complex febrile seizures and febrile status epilepticus and the lower incidence or improved treatment of brain infections have been considered possible explanations for reduced anteromesial temporal surgeries. 12 Owing to our methodology of data collection, we could not assess whether there was a prominent decrease in International League Against Epilepsy HS type 1, 20 which is most often associated with a history of initial precipitating injuries before 5 years of age.…”

Section: Proportion Of Mcdsmentioning

confidence: 99%

“…In several previous US and European surveys, decreased or stable numbers of resective procedures have been documented in adults, whereas surgical volumes have steadily grown in pediatric settings. At odds with these findings, a recent European multicenter survey reported an increased utilization of epilepsy surgery in both adults and children, and a single center assessment in Germany described stable volumes of pediatric surgical procedures from 1990 to 2014.…”

Section: Introductionmentioning

confidence: 99%

“…an increased utilization of epilepsy surgery in both adults and children, and a single center assessment in Germany 14 described stable volumes of pediatric surgical procedures from 1990 to 2014.…”

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confidence: 99%

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Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

et al. 2019

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Objective To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. Methods We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. Results We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P < .0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend = .0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend = .0047) and a significant decrease in unilobar temporal surgeries (P for trend = .0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo‐electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. Significance Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures.

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Section: Discussionsupporting

confidence: 86%

Section: Proportion Of Mcdsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

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“…We retrospectively assessed patients only after admission to the epilepsy monitoring unit of the Epilepsy Center Bethel; in some patients, a diagnosis of generalized epilepsy was made only after epilepsy surgery. All ten reported cases fulfilled the ILAE criteria of refractory epilepsy.…”

Section: Methodsmentioning

confidence: 99%

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

et al. 2020

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractObjective: Some patients with genetic generalized epilepsy (GGE) may present with ambiguous and atypical findings and even focal brain abnormalities. Correct diagnosis may therefore be difficult. Methods: We retrospectively collected six patients investigated on the epilepsy monitoring unit with MRI abnormalities mimicking focal cortical dysplasia (FCDlike) or heterotopias, but with semiology and EEG features of GGE. We compared them to four additional patients with GGE and nonmigratory abnormalities. Results: All six patients presented with frontal MRI lesions: radial ("transmantle," n = 4), cortical-subcortical (n = 1), and periventricular heterotopia (n = 1). Five had positive family histories. Semiologic lateralizing signs compatible with the lesion were seen in four. Five patients had 3/s spike-wave complexes, with an asymmetric appearance in three. Regional EEG changes matched with the side of the abnormality in three patients. Invasive EEG (n = 2) or postoperative outcomes (n = 3) argued against an ictogenic role of the MRI abnormalities. Histology showed mild malformation of cortical development, but no focal cortical dysplasia. The six patients were finally diagnosed with juvenile myoclonic epilepsy (n = 2), juvenile absence epilepsy (n = 2), or GGE not further specified (nfs, n = 2). Compared to these patients, the other four (final diagnoses: childhood absence epilepsy, n = 1; perioral myoclonia with absences, n = 1; and GGE nfs, n = 2) had no lateralizing EEG findings. Significance: Patients with GGE may have coincidental MRI abnormalities. These cases are challenging as frontal epilepsy and GGE can present with similar semiologies. GGE with coincidental FCD-like lesions/heterotopias is in particular difficult to diagnose as patients have more lateralizing features (in semiology and EEG) than those with tumors. A detailed noninvasive presurgical evaluation may be justified. We point out red flags that may help to distinguish GGE from frontal epilepsy, even in the presence of brain abnormalities: 3/s spike waves (even if asymmetric), changing lateralizing signs at different times, and a positive family history hinting at GGE.

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Pediatric Epilepsy Surgery

Zentner¹

2020

Surgical Treatment of Epilepsies

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Differences in pediatric and adult epilepsy surgery: A comparison at one center from 1990 to 2014

Cited by 35 publications

References 48 publications

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

Pediatric Epilepsy Surgery

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