Long-Term Outcomes of Epilepsy Surgery in School-Aged Children With Partial Epilepsy

Han

Rolston

et al. 2014

PED

Object Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear. Methods The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted. Results Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II–IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%). Conclusions While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.

Section: Discussionmentioning

confidence: 99%

Epilepsy surgery failure in children: a quantitative and qualitative analysis

Han

Rolston

et al. 2014

PED

“…Other investigators have described a similar relationship between epilepsy duration and seizure outcomes, 41,58 sug gesting that earlier operative therapy may improve the likelihood of Engel Class I outcome. Furthermore, sev eral studies have shown that pediatric patients who at tain seizure control postoperatively may also benefit from improved intellectual and cognitive ability, 42,53 better memory function, 40 decreased medication use and side effects, 32,46 fewer behavioral problems, 45 and overall im proved quality of life 38,40 compared with patients with continued seizures. Patient and family surveys have also suggested higher levels of education, employment status, independence, and overall satisfaction associated with Engel Class I outcome compared with other Engel class outcomes.…”

Section: Discussionmentioning

confidence: 99%

Seizure outcomes after resective surgery for extra–temporal lobe epilepsy in pediatric patients

Breshears

Sun

et al. 2013

PED

135

While temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults, seizures in children are more often extratemporal in origin. Extra–temporal lobe epilepsy (ETLE) in pediatric patients is often medically refractory, leading to significantly diminished quality of life. Seizure outcomes after resective surgery for pediatric ETLE vary tremendously in the literature, given diverse patient and epilepsy characteristics and small sample sizes. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after resective surgery for ETLE, excluding hemispherectomy. Thirty-six studies were examined. These 36 studies included 1259 pediatric patients who underwent resective surgery for ETLE. Seizure freedom (Engel Class I outcome) was achieved in 704 (56%) of these 1259 patients postoperatively, and 555 patients (44%) continued to have seizures (Engel Class II–IV outcome). Shorter epilepsy duration (≤ 7 years, the median value in this study) was more predictive of seizure freedom than longer (> 7 years) seizure history (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.07–2.14), suggesting that earlier intervention may be beneficial. Also, lesional epilepsy was associated with better seizure outcomes than nonlesional epilepsy (OR 1.34, 95% CI 1.19–1.49). Other predictors of seizure freedom included an absence of generalized seizures (OR 1.61, 95% CI 1.18–2.35) and localizing ictal electroencephalographic findings (OR 1.55, 95% CI 1.24–1.93). In conclusion, seizure outcomes after resective surgery for pediatric ETLE are less favorable than those associated with temporal lobectomy, but seizure freedom may be more common with earlier intervention and lesional epilepsy etiology. Children with continued debilitating seizures despite failure of multiple medication trials should be referred to a comprehensive pediatric epilepsy center for further medical and surgical evaluation.

“…While all patients are at risk for neurologic or cognitive decline with persistent uncontrolled seizures, the cumulative effects of epilepsy are a particular concern in children given ongoing neurodevelopment. Various investigators have shown that seizure control in children is associated with improved cognitive and intellectual ability (Liu et al, 2007; Souza-Oliveira et al, 2012), better memory function (Liang et al, 2012), fewer behavioral problems (Mikati et al, 2010), diminished medication use and side-effects (Keene et al, 1998a; Mikati et al, 2008), and an overall improvement in quality of life (Larysz et al, 2007; Liang et al, 2012) compared to patients with continued seizures. Family surveys have also demonstrated higher levels of education, independence, employment status, and overall satisfaction associated with seizure freedom in pediatric patients (Keene et al, 1998a, b).…”

Section: Surgicaltherapymentioning

confidence: 99%

Epilepsy and brain tumors

Handbook of Clinical Neurology

Chang

Vecht

2016

185

138

Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70–80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60–75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20–50% of patients with meningioma and 20–35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60–90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.