Seizure outcomes after temporal lobectomy in pediatric patients

Abstract

<jats:p>Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults and is responsible for 15%–20% of epilepsy cases in children. Class I evidence strongly supports the use of temporal lobectomy for intractable TLE in adults, but fewer studies have examined seizure outcomes and predictors of seizure freedom after temporal lobectomy in pediatric patients. 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 temporal lobectomy for TLE. Thirty-six studies met their inclusion criteria. These 36 studies included 1318 pediatric patients with a mean age (± SEM) of 10.7 ± 0.3 years. Overall, seizure freedom (Engel Class I outcome) was achieved in 1002 cases (76%); 316 patients (24%) continued to have seizures (Engel Class II–IV outcome). All patients had at least 1 year of follow-up. Statistically significant predictors of seizure freedom after surgery included lesional epilepsy etiology (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02–1.15), abnormal findings on preoperative MRI (OR 1.27, 95% CI 1.16–1.40), and lack of generalized seizures (OR 1.36, 95% CI 1.20–1.56). Among lesional epilepsy cases, there was a trend toward better outcome with gross-total lesionectomy than with subtotal resection. Approximately three-fourths of pediatric patients with TLE attain seizure freedom after temporal lobectomy. Favorable outcomes may be predicted by lesional epilepsy etiology, abnormal MRI, and lack of generalized seizures. Pediatric patients with medically refractory TLE should be referred to a comprehensive pediatric epilepsy center for surgical evaluation.</jats:p>

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

“…Our observations suggest that outcomes after resective surgery for pediatric ETLE are less favor able than those associated with temporal lobectomy for TLE, after which 60%-100% of patients become seizure free. 24,44,54 Nevertheless, over half of children with ETLE in this report did respond well to resection. Given the significant burden of disease associated with intractable ETLE in children, surgical therapy remains an important treatment option in selected patients after medical thera py has failed.…”

“…1,24,51 Medically refractory extra-temporal lobe epi lepsy (ETLE) is associated with a significant burden of disease in the pediatric population, leading to progressive cognitive deficits, social and behavioral problems, dimin ished quality of life, and an increased risk of death. 16,37,46 Furthermore, AEDs used to treat these seizures often have unfavorable side effect profiles in children.…”

Epilepsy surgery in children and adolescents: Report on 43 cases

“…A meta-analysis that included 36 studies and 1259 pediatric patients with extratemporal epilepsy showed that post-operative prognosis corresponded to Engel I class in 56% of patients; another meta-analysis that included 36 studies and 1318 pediatric patients with temporal epilepsy showed that post-operative prognosis was Engel I in 76% of them. 8,9 Such difference in the percentage of Engel I patients is likely due to the fact that, in our population, there was a high percentage of FCD and a prolonged latency period until surgery. Both factors were associated, in different series, with a worse post-operative seizure prognosis.…”

Cirugía de la epilepsia en niños y adolescentes: experiencia de 43 casos

“…Un metaanálisis que incluyó 36 estudios con 1259 pacientes pediátricos con epilepsias extratemporales mostró que el pronóstico posquirúrgico resultó en Engel I en el 56% de los pacientes, y otro metaanálisis que incluyó 36 estudios con 1318 pacientes pediátricos con epilepsias temporales evidenció que el pronóstico posquirúrgico fue Engel I en el 76% de los pacientes. 8,9 Adjudicamos esta diferencia en el porcentaje de pacientes con Engel I, probablemente, debido a que, en nuestra población, tenemos un alto porcentaje de DCF y a la prolongada latencia de tiempo hasta la cirugía en nuestra población. Ambos factores en distintas series se asociaron a un peor pronóstico de crisis posquirúrgicas.…”