Epilepsy surgery in children

Abstract

Approximately 60% of all patients with epilepsy suffer from focal epilepsy syndromes. In approximately 15% of these patients, the seizures are not adequately controlled with anticonvulsive drugs, and such patients are potential candidates for surgical treatment and majority are children. Epilepsy surgery in children, who have been carefully chosen, can result in either seizure freedom or a marked (>90%) reduction in seizures in approximately two-third of children with intractable seizures. In the multimodality presurgical evaluation approach, sufficient concordance should be established among various independent investigations, thus identifying the location and extent of the epileptogenic zone with a high degree of confidence. Early surgery improves the quality of life and cognitive and developmental outcome of the child. Surgically remediable epilepsies in children should be identified early and include temporal lobe epilepsy with focal lesions, lesional extratemporal epilepsies, hemispherical epilepsies, and gelastic epilepsy with hypothalamic hamartoma, and can be treated by resective or disconnection surgery. Palliative procedures include corpus callosotomy and vagal nerve stimulation for children with diffuse and multifocal epilepsies, who are not candidates for resective surgery. Deep brain stimulation in patients with epilepsy is still under evaluation. For children with "surgically remedial epilepsy," surgery should be offered as a procedure of choice rather than as a treatment of last resort.

Speech Analysis Using Artificial Intelligence as a Peri-Operative Evaluation: A Case Report of a Patient with Temporal Lobe Epilepsy Secondary to Tuberous Sclerosis Complex Who Underwent Epilepsy Surgery

“…Improvements in cognition [ 1 ], mood [ 2 ] and social skills [ 3 ] have been reported after epilepsy surgery. Such differences have been explained hypothetically by improvements in the intelligence quotient (IQ) after epilepsy surgery [ 4 , 5 ]. In the real world, the fact that not all patients who undergo epilepsy surgery show postoperative improvements in IQ has also been reported [ 6 , 7 ].…”

Stereotactic Radiosurgery for Treatment of Operculoinsular Refractory Epilepsy After Incomplete Resection in a Child

“…2 After undergoing excisional surgery for refractory epilepsy, children have improved quality of life with a complication rate of less than 5%. 3 In addition to standard epilepsy surgery, stereotactic radiosurgery (SRS) can eliminate focal epileptogenic lesions in both adults and children. Recent studies on the use of radiosurgery in the treatment of focal epilepsy suggest that medically intractable seizures remit at clinically significant rates following SRS.…”

miR‐34a carried by adipocyte exosomes inhibits the polarization of M1 macrophages in mouse osteolysis model

“…Macrophages are known to be capable of switching phenotype into different types of polarization states, that is, an inflammation‐related M1‐type, and healing‐related M2‐type in response to external cues 2 . M1‐type macrophage polarization can be promoted by Ti particles 3,4 .…”