Surgery for epileptogenic cerebral dysplasia in children

Hidalgo, Eveline Teresa; Weiner, Howard L.

doi:10.1111/dmcn.13292

Cited by 3 publications

(4 citation statements)

References 55 publications

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“…5 Several fundamental changes have led to the widespread surgical treatment for DRE in children, based on a risk-benefit analysis of pediatric epilepsy surgery, and a change in our overall approach to evaluation. 6 Recent advances in neuroimaging and electrophysiology have contributed to presurgical evaluation and improvement of peri-surgical management. However, there are still remaining misconceptions regarding surgical options, which may make general neurologist and families reluctant to use the epilepsy surgical treatment, such as the idea that all drugs need to be tried, and bilateral EEG spikes or normal MRI were contraindications to surgery.…”

Section: Introductionmentioning

confidence: 99%

Recent Aspects of Pediatric Epilepsy Surgery

Kwon¹,

Kim²

2020

J Epilepsy Res

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Surgery has been and is now a well-established treatment indicated for adults and children with drug-resistant epilepsy (DRE). The surgical landscape for children with DRE appears to be expanding, and surgical cases of pediatric epilepsy have increased significantly in the past decade, contrary to adult epilepsy. Several fundamental changes have led to the widespread surgical treatment for DRE in children, based on a risk-benefit analysis of pediatric epilepsy surgery, and a change in our overall approach to evaluation. There are unique and age-related differences associated with pediatric epilepsy surgery, characterized by different types of etiologies, concerns for developmental progress, and safety issues. Indications for "pediatric epilepsy surgery" have been broadened to include a wide spectrum of etiologies without excluding children with "generalized" seizures, "generalized or multifocal eletroencephlography", or patients with contra-lateral epileptiform activity or magnetic resonance imaging abnormalities. Furthermore, epilepsy surgery is increasingly considered in infancy and early childhood, which has similar surgical outcomes as the case of late childhood, in an effort to improve the eventual development outcome. Seizure freedom, or at least seizure reduction, is an excellent result with resolution of the associated epileptic encephalopathy, normalization of the EEG, and decrease in the total epileptic burden in the pediatric field.

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Section: Introductionmentioning

confidence: 99%

Recent Aspects of Pediatric Epilepsy Surgery

Kwon¹,

Kim²

2020

J Epilepsy Res

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“…Precise and complete resection of the epileptogenic and seizure onset zones and the epileptogenic lesion is associated with successful surgical outcomes. [9][10][11] Complete resection of the epileptogenic zone has been associated with freedom from seizures. 12,13 Evaluation of the functional zone to prevent postoperative dysfunction is important when planning surgery.…”

Section: Introductionmentioning

confidence: 99%

18F-FDG-PET/CT for Localizing the Epileptogenic Focus in Patients with Different Types of Focal Cortical Dysplasia

Wang,

Hong,

Zhang

et al. 2024

NDT

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To determine the diagnostic and localization value of 18 F-fluorodeoxyglucose-positron emission tomography (PET)/ computed tomography (CT) in patients with focal cortical dysplasia (FCD) who underwent epilepsy surgery. Methods: One hundred and eight patients with pathologically proven FCD who underwent surgery for refractory epilepsy were retrospectively analyzed. All patients underwent magnetic resonance imaging (MRI), 18 F-FDG-PET/CT, and video electroencephalography. An MRI diagnosis of FCD was defined as MRI+. A PET/CT diagnosis of FCD was defined as PET/CT+. Results: MRI and PET/CT detected FCD in 20.37% and 93.52% of patients, respectively. The difference was significant. Twenty-one patients were MRI+/PET+, 80 were MRI-/PET+, six were MRI-/PET-, and one was MRI+/PET-. The MRI positivity rate was lowest in patients with FCD type IIIa (5.6%, P < 0.05). Prevalence of MRI-/PET+ was highest in patients with FCD type IIIa (88.89%, P < 0.05). Conclusion: PET/CT is superior to MRI in detecting FCD. FCD type IIIa was more likely than other types to show MRI-/PET+. This suggests that PET/CT has particular diagnostic value for FCD type IIIa patients with negative MRI findings.

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“…2 Surgical treatment for patients with intractable epilepsy is highly effective in select patients. 3,4 However, surgical evaluation and treatment can be costly and complex, and it requires expertise and support at multiple levels. This results in large barriers to surgical treatment in low-or middle-income countries such as in Panama.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately one‐third of patients with epilepsy are resistant to treatment with antiepileptic drugs (AEDs) and develop intractable epilepsy . Surgical treatment for patients with intractable epilepsy is highly effective in select patients . However, surgical evaluation and treatment can be costly and complex, and it requires expertise and support at multiple levels.…”

Section: Introductionmentioning

confidence: 99%

Epilepsy surgery in Panama: Establishment of a successful hybrid program as a model for small middle‐income countries

et al. 2018

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Summary Objective The majority of the 65 million people worldwide with epilepsy live in low‐ and middle‐income countries. Many of these countries have inadequate resources to serve the large patient population affected by epilepsy. Panama is a middle‐income country that currently has only 2 facilities that can provide basic epilepsy services and no epilepsy surgery services. To address this need, a group of Panamanian physicians partnered with U.S. epilepsy health care providers to test a hybrid epilepsy surgery program, combining resources and expertise. Methods From 2011 to 2017, a multidisciplinary team of neurologists, neurosurgeons, and an electroencephalography (EEG) technician from the United States traveled to Panama 6 times and, in collaboration with the local team, performed surgical procedures for intractable epilepsy at the national children's hospital. Resective surgeries were performed with intraoperative electrocorticography and/or implantation of subdural and depth electrodes and extra‐operative monitoring. Cost was calculated using Panama government data. Results Twenty‐seven children with intractable epilepsy were surgically treated. Fifteen children are seizure‐free (Engle class I), 11 children are Engel II, and one child is Engel III. No major morbidity or mortality occurred, with only one postoperative infection. The average cost of treatment was calculated at $9850 per patient. Significance This program is a model for creating a multinational and multi‐institutional collaboration to provide surgical epilepsy treatment in a middle‐income country without an adequate infrastructure. To be successful, this collaboration needed to address medical, technical, and cultural challenges. This partnership helps to alleviate some of the present need for surgical epilepsy services while laying the groundwork for the development of a future local independent epilepsy surgery program.

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Surgery for epileptogenic cerebral dysplasia in children

Cited by 3 publications

References 55 publications

Recent Aspects of Pediatric Epilepsy Surgery

Recent Aspects of Pediatric Epilepsy Surgery

18F-FDG-PET/CT for Localizing the Epileptogenic Focus in Patients with Different Types of Focal Cortical Dysplasia

Epilepsy surgery in Panama: Establishment of a successful hybrid program as a model for small middle‐income countries

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