Pediatric epilepsy surgery: Past, present, and future

Duchowny, Michael

doi:10.1111/epi.16436

Cited by 3 publications

(5 citation statements)

References 11 publications

(20 reference statements)

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“…12 Epilepsy surgery yields significantly greater life expectancy compared to medical treatment in children with DRE, yet it is underutilized. 6 Our group has previously shown the feasibility and safety of epilepsy surgery in children with ASD, emphasizing the potential for better seizure control and associated gains in cognition with reductions in violent behavior. 12 Not surprisingly, children with ASD and MRI-negative epilepsy, similar to the two presented here, appeared to have worse outcomes than their lesional counterparts after an irreversible ablative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The burden of DRE coupled with ASD is high 12 . Epilepsy surgery yields significantly greater life expectancy compared to medical treatment in children with DRE, yet it is underutilized 6 . Our group has previously shown the feasibility and safety of epilepsy surgery in children with ASD, emphasizing the potential for better seizure control and associated gains in cognition with reductions in violent behavior 12 .…”

Section: Discussionmentioning

confidence: 99%

“…We have used RNS in children (off-label) [3][4][5] and adults, and have found no difference in safety or efficacy in our early experience. To reach a dramatically underserved population, children with MR-negative epilepsy, 6 we have broadened the scope of RNS utilization. A recent study has shown reproducible evidence of a cortically driven process within the epileptic network of LGS.…”

Section: Introductionmentioning

confidence: 99%

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Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

Kwon

Schüpper

Fields

et al. 2020

Ann Clin Transl Neurol

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The RNS System is not approved in patients under 18, although a critical need for novel treatment modalities in this vulnerable population persist. We present two pediatric patients with drug-resistant epilepsy secondary to Lennox-Gastaut Syndrome (LGS) and autism spectrum disorder (ASD) treated with the RNS System. Both patients have experienced 75-99% clinical seizure reductions in >1 year of follow-up. We illustrate that children with diffuse onset, multifocal epilepsy, including frontal and thalamic circuits thought to exist in the generation of LGS seizures, can be treated with responsive neurostimulation safely and effectively, targeting thalamic networks, and avoiding palliative disconnections and resections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

Kwon

Schüpper

Fields

et al. 2020

Ann Clin Transl Neurol

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“…The number of PubMed publications incorporating the phrase “pediatric epilepsy surgery” more than tripled from 100 publications in 2010 to 349 in 2021 2 . However, methods for reporting and measuring clinical outcomes in these cases are not standardized and unvalidated outcome scales predominate 3–6 . Organizations such as the National Institute of Neurological Disorders (NINDS), International League Against Epilepsy (ILAE), and the Patient‐Reported Outcomes Measurement Information System (PROMIS) have bolstered initiatives to develop and disseminate reliable, validated, and patient‐centric outcomes metrics 7–9 .…”

Section: Introductionmentioning

confidence: 99%

“…2 However, methods for reporting and measuring clinical outcomes in these cases are not standardized and unvalidated outcome scales predominate. [3][4][5][6] Organizations such as the National Institute of Neurological Disorders (NINDS), International League Against Epilepsy (ILAE), and the Patient-Reported Outcomes Measurement Information System (PROMIS) have bolstered initiatives to develop and disseminate reliable, validated, and patient-centric outcomes metrics. [7][8][9] The extent to which these initiatives have been applied in the pediatric epilepsy literature has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Quantifying and reporting outcome measures in pediatric epilepsy surgery: A systematic review

et al. 2022

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Several instruments and outcomes measures have been reported in pediatric patients undergoing epilepsy surgery. The objective of this systematic review is to summarize, evaluate, and quantify outcome metrics for the surgical treatment of pediatric epilepsy that address seizure frequency, neuropsychological, and healthrelated quality of life (HRQL). We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify publications between 2010 and June 2021 from PubMed, Embase, and the Cochrane Database of Systematic Reviews that report clinical outcomes in pediatric epilepsy surgery. Eighty-one articles were included for review. Overall, rates of postoperative seizure frequency were the most common metric reported (n = 78 studies, 96%). Among the seizure frequency metrics, the Engel Epilepsy Surgery Outcome Scale (n = 48 studies, 59%) was most commonly reported.Neuropsychological outcomes, performed in 32 studies (40%) were assessed using 36 different named metrics. HRQL outcomes were performed in 16 studies (20%) using 13 different metrics. Forty-six studies (57%) reported postoperative changes in antiepileptic drug (AED) regimen, and time-to-event analysis was performed in 15 (19%) studies. Only 13 outcomes metrics (1/5 seizure frequency, 6/13 HRQL, 6/36 neuropsychological) have been validated for use in pediatric patients with epilepsy and only 13 have been assessed through reliability studies (4/5 seizure frequency, 6/13 HRQL, and 3/36 neuropsychological). Of the 81 included studies, 17 (21%) used at least one validated metric. Outcome variable metrics in pediatric epilepsy surgery are highly variable. Although nearly all studies report seizure frequency, there is considerable variation in reporting.HRQL and neuropsychological outcomes are less frequently and much more heterogeneously reported. Reliable and validated outcomes metrics should be used to increase standardization and accuracy of reporting outcomes in pediatric patients undergoing epilepsy surgery.

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Autism Spectrum Disorder and Epilepsy

Kwon¹,

Wirrell

2022

Neurologic Clinics

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Pediatric epilepsy surgery: Past, present, and future

Cited by 3 publications

References 11 publications

Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

Quantifying and reporting outcome measures in pediatric epilepsy surgery: A systematic review

Autism Spectrum Disorder and Epilepsy

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