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Letén HM, Karterud HN, Mengshoel AM. Individuals' invisible work continues after epilepsy surgery: A qualitative interview study. Epilepsy Res 2024; 199:107281. [PMID: 38101177 DOI: 10.1016/j.eplepsyres.2023.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE How do persons with epilepsy (PWE) experience their everyday lives after epilepsy surgery? METHODS Qualitative thematic interviews were conducted with eight PWEs (30 to 60 years old). They were recruited when coming for post-operative control 1 to 5 years after epilepsy surgery. The interviews were transcribed. They were analysed by thematic analysis and inspired by Goffman who examines everyday life activities as a theatre play. RESULTS Before surgery, a substantial invisible and hidden work of adjustments was performed to prevent seizures, to secure help from others if seizures occurred, and to protect oneself from others' gaze during a seizure. This invisible work continued after surgery even for those who became seizure-free; but now for the purpose of protecting oneself from relapse of epilepsy. From the participants perspective there was no or minor change in daily activities among those not becoming seizure-free after surgery. In contrast, those who became seizure-free enjoyed the freedom to participate in social activities without planning or restrictions. CONCLUSIONS A striking finding was that daily life after surgery comprises considerably invisible work to protect a social self, and this preventive and protective invisible work continued, although those who became seizure-free were living an ordinary socially healthy life.
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Affiliation(s)
- Helene Myklebust Letén
- National Centre for Epilepsy (SSE), Neurological clinic, Oslo University Hospital, Norway.
| | - Hilde Nordahl Karterud
- National Centre for Epilepsy (SSE), Neurological clinic, Oslo University Hospital, Norway
| | - Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Norway
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Hoppe C, Beeres K, Witt J, Sassen R, Helmstaedter C. How are they doing as adults? Psychosocial and socioeconomic outcomes 11-30 years after pediatric epilepsy surgery. Epilepsia Open 2023; 8:797-810. [PMID: 37003960 PMCID: PMC10472367 DOI: 10.1002/epi4.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Pediatric epilepsy surgery yields cure from epilepsy or complete seizure control with continued medication in many patients early in life. This study aimed to evaluate the long-term (>10 years) psychosocial and socioeconomic outcomes of pediatric epilepsy surgery and examine the role of comorbid disability, type of surgery, seizure freedom, and age at surgery. METHODS A novel ad hoc parent/patient questionnaire was used to assess educational and occupational attainment, marital/familial status, mobility, and other outcomes in patients who underwent unilobar or multilobar surgery for drug-refractory epilepsy during their childhood. The questionnaire also captured information on comorbid disability. RESULTS Of the 353 eligible patients, 203 could still be contacted and 101 of these (50%) returned appropriately filled-in questionnaires (follow-up intervals: 11-30 [mean: 19.6] years). The cure from epilepsy rate was 53%. Type of surgery was strongly confounded by comorbid disability. Patients with comorbid disabilities had significantly lower rates of regular school degrees, gainful employment, marriage, and driving license (N = 29; 12%, 4%, 0%, 3%) compared with non-disabled patients (N = 69; 89%, 80%, 43%, and 67%, respectively). Patients achieved lower school degrees than their siblings and parents. Non-disabled seizure-free patients had better employment and mobility outcomes compared with non-seizure-free patients. Age at surgery (<10 vs. ≥10 years of age) did not have any effect on any outcome in patients with preschool seizure onset. SIGNIFICANCE Pediatric epilepsy surgery can lead to permanent relief from epilepsy in many patients, but comorbid disability strongly impacts adult life achievement. In non-disabled patients, favorable outcomes in academic, occupational, marital, and mobility domains were achieved, approaching respective rates in the German population. Complete seizure freedom had additional positive effects on employment and mobility in this group. However, in case of chronic comorbid disability the overall life prospects may be limited despite favorable seizure outcomes.
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Affiliation(s)
- Christian Hoppe
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | | | | | - Robert Sassen
- Department of EpileptologyUniversity Hospital BonnBonnGermany
- Department of NeuropediatricsUniversity Hospital BonnBonnGermany
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Mir A, Jallul T, Alotaibi F, Amer F, Najjar A, Alhazmi R, Al Faraidy M, Alharbi A, Aldurayhim F, Barnawi Z, Fallatah B, Ali M, Almuhaish H, Almolani F, Suwailem A, Tuli M, Naim A, Hassan S, Hedgcock B, Bostanji G, Bashir S, AlBaradie R. Outcomes of resective surgery in pediatric patients with drug-resistant epilepsy: A single-center study from the Eastern Mediterranean Region. Epilepsia Open 2023; 8:930-945. [PMID: 37162422 PMCID: PMC10472393 DOI: 10.1002/epi4.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/07/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE Epilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug-resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE. METHODS Patients with focal DRE who had undergone epilepsy surgery were included in the present study. All patients underwent a comprehensive presurgical evaluation. Postoperative seizure outcomes were classified using the Engel Epilepsy Surgery Outcome Scale. RESULTS After surgery, 33 patients (62.2%) were Class I according to the Engel classification of surgical outcomes; eight patients (15.0%) were Class II, 11 (20.7%) were Class III, and one (1.8%) was Class IV. The relationships of presurgical, surgical, and postsurgical clinical variables to seizure outcomes were compared. Older age at seizure onset, older age at the time of surgery, the presence of focal to bilateral tonic-clonic seizures, seizure duration over 2 minutes, unsuccessful treatment with three or fewer antiseizure medications, lesions confined to one lobe (as demonstrated via magnetic resonance imaging [MRI]), surgical site in the temporal lobe, and histopathology including developmental tumors were significantly linked to an Engel Class I outcome. A univariate analysis of excellent surgical outcomes showed that lateralized semiology, localized interictal and ictal electroencephalogram (EEG) discharges, lateralized single-photon emission computed tomography and positron emission tomography findings, and temporal lobe resections were significantly related to excellent seizure outcomes. SIGNIFICANCE The results of our study are encouraging and similar to those found in other centers around the world. Epilepsy surgery remains an underutilized treatment for children with DRE and should be offered early.
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Affiliation(s)
- Ali Mir
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Tarek Jallul
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Faisal Alotaibi
- Neuroscience CentreKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Fawzia Amer
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
- Department of Pediatric Neurology and MetabolicCairo University Children HospitalCairoEgypt
| | - Ahmed Najjar
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
- Department of Surgery, College of MedicineTaibah UniversityAlmadinah AlmunawwarahSaudi Arabia
| | - Rami Alhazmi
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mona Al Faraidy
- Anesthesia DepartmentKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Alanoud Alharbi
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Fatimah Aldurayhim
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Zakia Barnawi
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Bassam Fallatah
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mona Ali
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Husam Almuhaish
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Fadhel Almolani
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Abdullah Suwailem
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mahmoud Tuli
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Abdulrahman Naim
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Suad Hassan
- Department of Mental HealthKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Brent Hedgcock
- Department of NeurophysiologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Ghadah Bostanji
- Department of Social WorkKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Shahid Bashir
- Neuroscience CentreKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Raidah AlBaradie
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
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Katlowitz KA, Athukuri P, Sharma H, Dang H, Soni A, Khan AB, Malbari F, Gadgil N, Weiner HL. Seizure outcomes after resection of primary brain tumors in pediatric patients: a systematic review and meta-analysis. J Neurooncol 2023; 164:525-533. [PMID: 37707753 DOI: 10.1007/s11060-023-04446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Primary brain neoplasms are the most common solid tumors in pediatric patients and seizures are a common presenting symptom. Surgical intervention improves oncologic outcomes and seizure burden. A better understanding of factors that influence seizure outcomes in the surgical management of primary brain tumors of childhood can guide treatment approach thereby improving patient quality of life. METHODS We performed a systematic analysis using articles queried from PubMed, EMBASE, and Cochrane published from January 1990 to August 2022 to determine predictors of seizure outcomes in pediatric patients undergoing resection of primary brain tumors. RESULTS We identified 24 retrospective cohort studies, one prospective cohort study, and one mixed retrospective and prospective study for the systematic analysis. A total of 831 pediatric patients were available for analysis. 668 (80.4%) patients achieved seizure freedom after surgery. Complete tumor resection increased the likelihood of a seizure-free (Engel I) outcome compared to subtotal resection (OR 7.1, 95% CI 2.3-21.9). Rates of Engel I seizure outcomes did not significantly differ based on factors such as age at seizure onset, duration of epilepsy, gender, tumor laterality, or age at surgery, but trended towards significance for improved outcomes in temporal lobe tumors. CONCLUSION Primary brain tumors in the pediatric population are commonly associated with seizures. Resection of these lesions reduces seizure burden and is associated with high rates of seizure freedom. Complete resection, compared to subtotal resection, significantly increases the likelihood of seizure-free outcomes.
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Affiliation(s)
- Kalman A Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Prazwal Athukuri
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Huy Dang
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Astitva Soni
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - A Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Fatema Malbari
- Department of Pediatrics, Division of Child Neurology and Neurodevelopmental Disabilities, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Department of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Hoppe C, Beeres K, Witt JA, Sassen R, Helmstaedter C. Clinical adult outcome 11-30 years after pediatric epilepsy surgery: Complications and other surgical adverse events, seizure control, and cure of epilepsy. Epilepsia 2023; 64:335-347. [PMID: 36468792 DOI: 10.1111/epi.17477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pediatric epilepsy surgery promises seizure freedom or even cure of epilepsy. We evaluated the long-term (≥10 years) adult clinical outcome including surgery-related adverse events and complications, which are generally underreported. METHODS A monocentric, single-arm, questionnaire study in now adult patients who underwent epilepsy surgery during childhood. A novel ad hoc parental/patient questionnaire, which addressed diverse outcome domains was applied. RESULTS From a total of 353 eligible patients, 203 could be contacted (3 patients died of causes unknown) and 101 (50%) returned appropriately filled-in surveys. No evidence for a survey-response bias was found. The rate of surgical complications according to the patient records was 9%. As regards the survey, half of the parents/patients reported surgical adverse events (expected and unexpected issues) and one-third reported permanent aversive sequels. Two-thirds of the patients were seizure-free during the last year before follow-up; 63% were Engel class 1A; favorable seizure outcomes (including auras only) were obtained in 73%; and 54% were seizure-free and off antiseizure medicine (ASM), that is, cured of epilepsy. In non-seizure-free patients, seizure relapse occurred at any time during the follow-up interval but 87% of those with a seizure-free first postoperative year were seizure-free at follow-up. One patient experienced a seizure relapse during the ASM withdrawal trial but became seizure-free again with ASMs. Eleven patients reported an increased number of ASMs as compared to the time before surgery. Earlier focal surgery did not affect the long-term clinical outcome. SIGNIFICANCE Pediatric epilepsy surgery was capable of curing epilepsy in about one-half of the children and to significantly control seizures in about three-fourths. Long-term success of focal surgery did not depend on age at surgery or duration of epilepsy. Surgical adverse events including complications may be underreported and must be assessed more thoroughly.
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Affiliation(s)
- Christian Hoppe
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kassandra Beeres
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Robert Sassen
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuropediatrics, University Hospital Bonn, Bonn, Germany
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Harris W, Brunette-Clement T, Wang A, Phillips HW, Brelie CVD, Weil AG, Fallah A. Long-term Outcomes of Pediatric Epilepsy Surgery: Individual Participant Data and Study Level Meta-Analyses. Seizure 2022; 101:227-236. [DOI: 10.1016/j.seizure.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/13/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022] Open
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Cross JH, Reilly C, Gutierrez Delicado E, Smith ML, Malmgren K. Epilepsy surgery for children and adolescents: evidence-based but underused. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:484-494. [DOI: 10.1016/s2352-4642(22)00098-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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Romanowski EF, McNamara N. Surgery for Intractable Epilepsy in Pediatrics, a Systematic Review of Outcomes other than Seizure Freedom. Semin Pediatr Neurol 2021; 39:100928. [PMID: 34620460 DOI: 10.1016/j.spen.2021.100928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022]
Abstract
To perform a systematic review evaluating reported outcomes for epilepsy surgery in pediatric patients with pharmacoresistant epilepsy beyond seizure control, including impact on quality of life, behavioral, neurocognitive outcomes as well as complications, and death. We reviewed articles from both EMBASE and MEDLINE/PubMed articles that met formal criteria (patients ≤18 years, those with intractable epilepsy, at least 5 patients in the case series, published in peer-reviewed journal). Each reviewer independently reviewed the articles and those with discrepancies were discussed and consensus was reached. Out of a total of 536 abstracts obtained from EMBASE and MEDLINE/PubMed searches combined with additional cross-referencing, a total of 98 manuscripts ultimately met all inclusion criteria. The manuscripts were divided into 3 outcomes categories: Quality of Life (16), Cognitive Outcomes (60), and Deficits and Complications (50). Several papers fell into more than 1 category. These were separated by surgical types and evaluated. We found that overall reporting in all domains was variable and inconsistent amongst the different studies. This systematic review highlights the lack of completeness in reporting outcomes and complications involving pediatric epilepsy surgery and discordant results. This underscores the importance of multicenter systematic prospective data collection in pediatric patients who undergo pediatric epilepsy surgery.
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Affiliation(s)
| | - Nancy McNamara
- Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI.
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Beatty CW, Lockrow JP, Gedela S, Gehred A, Ostendorf AP. The Missed Value of Underutilizing Pediatric Epilepsy Surgery: A Systematic Review. Semin Pediatr Neurol 2021; 39:100917. [PMID: 34620465 DOI: 10.1016/j.spen.2021.100917] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Pediatric epilepsy surgery is underutilized. Only 1%-11% of children with drug resistant epilepsy (DRE) undergo surgical treatment, or less than half of those estimated to benefit. We conducted a systematic review of articles published in PubMed, EMBASE, and Web of Science in order to study the factors related to surgery underutilization as well as the impact on both the individual and the healthcare system. Our review demonstrates multiple factors leading to underutilization, including family misconceptions about epilepsy surgery, lack of provider knowledge, as well as systemic health disparities. While the upfront cost of epilepsy surgery is significant, the long-term financial benefits and reduced health resource utilization tilt the economic advantage in favor of surgery in children with DRE. Additionally, timely interventions improve seizure and cognitive outcomes with low risk of complications. Further interventions are needed at the levels of family, provider, and the healthcare system to increase access to pediatric epilepsy surgery.
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Affiliation(s)
- Christopher W Beatty
- The Ohio State University and Nationwide Children's Hospital, Division of Neurology, Department of Pediatrics, Columbus, OH
| | - Jason P Lockrow
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA
| | - Satyanarayana Gedela
- Emory University and Children's Healthcare of Atlanta, Division of Neurology, Department of Pediatrics, Atlanta, GA
| | - Alison Gehred
- Medical Library Division, Nationwide Children's Hospital, Columbus, OH
| | - Adam P Ostendorf
- The Ohio State University and Nationwide Children's Hospital, Division of Neurology, Department of Pediatrics, Columbus, OH.
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Nozaki T, Fujimoto A, Yamazoe T, Niimi K, Baba S, Yamamoto T, Sato K, Enoki H, Okanishi T. Freedom From Seizures Might Be Key to Continuing Occupation After Epilepsy Surgery. Front Neurol 2021; 12:585191. [PMID: 33643186 PMCID: PMC7907155 DOI: 10.3389/fneur.2021.585191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: We hypothesized that epilepsy surgery for adult patients with temporal lobe epilepsy (TLE) who obtained freedom from seizures could provide opportunities for these patients to continue their occupation, and investigated continuity of occupation to test this postulation. Methods: Data were obtained from patients who had undergone resective surgery for medically intractable TLE between October 2009 and April 2019 in our hospital. Inclusion criteria were as follows: (1) ≥16 years old at surgery; (2) post-operative follow-up ≥12 months; (3) seizure-free period ≥12 months. As a primary outcome, we evaluated employment status before and after surgery, classified into three categories as follows: Level 0, no job; Level 1, students or homemakers (financially supported by a family member); and Level 2, working. Neuropsychological status was also evaluated as a secondary outcome. Results: Fifty-one (87.9%) of the 58 enrolled TLE patients who obtained freedom from seizures after surgery continued working as before or obtained a new job (employment status: Level 2). A significant difference in employment status was identified between before and after surgery (p = 0.007; Wilcoxon signed-rank test). Twenty-eight patients (48.3%) were evaluated for neuropsychological status both before and after surgery. Significant differences in Wechsler Adult Intelligence Scale-III scores were identified between before and after surgery (p < 0.05 each; paired t-test). Conclusion: Seizure freedom could be a factor that facilitates job continuity, although additional data are needed to confirm that possibility. Further investigation of job continuity after epilepsy surgery warrants an international, multicenter study.
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Affiliation(s)
- Toshiki Nozaki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tomohiro Yamazoe
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keiko Niimi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takamichi Yamamoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Jennum P, Debes NMM, Ibsen R, Kjellberg J. Long-term employment, education, and healthcare costs of childhood and adolescent onset of epilepsy. Epilepsy Behav 2021; 114:107256. [PMID: 32622728 DOI: 10.1016/j.yebeh.2020.107256] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Childhood- and adolescent-onset epilepsy may have a significant impact on long-term educational and vocational status, which in turn has consequences for individuals' socioeconomic status. We estimated the factual long-term socioeconomic consequences and healthcare costs of individuals with diagnosed epilepsy. METHODS The prospective cohort study included Danish individuals with epilepsy onset before the age of 18 years, diagnosed between 2002 and 2016. Healthcare costs and socioeconomic data were obtained from nationwide administrative and health registers. The prediction was made with a general estimating equation (GEE). A total of 15,329 individuals were found with the diagnosis during this period and were followed until the age of 30 years. These were compared with 31,414 controls. We used 30 years as this represent an age where most has finalized their education, and as such represent the final educational level. Patients and their controls were subdivided into debut age groups of 0-5 and 6-18 years. Individuals were matched for age, gender, and residential location. RESULTS Compared with control groups, patients with epilepsy at the age of 30 years tended to have the following: 1) parents with lower educational attainment; 2) a significantly lower educational level when controlling for parental education attainment; 3) lower grade-point averages; 4) a lower probability of being in employment and lower income, even when transfer payments were considered; and 5) elevated healthcare costs, including those for psychiatric care. It was also noted that the long-term educational consequences for patients with epilepsy were associated with parental educational level. Differences were more pronounced for those with early (0-5 years) rather than later (6-18 years) onset epilepsy. CONCLUSIONS Epilepsy is associated with severe long-term socioeconomic consequences: lower educational level, school grades, employment status, and earned income. The presence of epilepsy is associated with parental educational level. LIMITATIONS SIGNIFICANT OUTCOMES.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical +Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | | | | | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark.
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Focal cortical dysplasia: etiology, epileptogenesis, classification, clinical presentation, imaging, and management. Childs Nerv Syst 2020; 36:2939-2947. [PMID: 32766946 DOI: 10.1007/s00381-020-04851-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is the most prevalent cause of intractable epilepsy in children. It was first described by Taylor et al. in 1971. In 2011, the International League against Epilepsy described an international consensus of classification for FCD. However, the exact mechanism causing this pathology remains unclear. The diagnosis and recognition of FCD increase with the advances in neuroradiology and electrophysiology. FOCUS OF REVIEW In this paper, we discuss the literature regarding management of FCD with a focus on etiology, pathophysiology, classification, clinical presentation, and imaging modalities. We will also discuss certain variables affecting surgical outcome of patients with FCD. CONCLUSION Based on our review findings, it is concluded that surgical management with complete resection of the lesion following preoperative localization of the epileptogenic zone in patients with FCD subtypes can provide a seizure-free outcome.
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Peng SJ, Wong TT, Huang CC, Chang H, Hsieh KLC, Tsai ML, Yang YS, Chen CL. Quantitative analysis of intraoperative electrocorticography mirrors histopathology and seizure outcome after epileptic surgery in children. J Formos Med Assoc 2020; 120:1500-1511. [PMID: 33214033 DOI: 10.1016/j.jfma.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Epileptic surgery is the potentially curative treatment for children with refractory seizures. The study aimed to quantify and analyze high frequency oscillation (HFO) ripples and interictal epileptiform discharges (EDs) in intraoperative electrocorticography (ECoG) between malformation of cortical dysplasia (MCD) and non-MCD children with MRI-lesional focal epilepsy, and evaluate of seizure outcomes after epileptic surgery. METHODS The intraoperative ECoG was performed before and after lesionectomy. Quantifications of HFO ripples and interictal EDs of ECoG by frequency, amplitude, and foci of intraoperative ECoG were performed based on electrode location, and the characteristics of ECoG recordings were analyzed in each patient based on their histopathology. Seizure outcome after surgery according to their quantitative ECoG findings was analyzed. RESULTS Frequency of EDs and HFO ripple rates in preresection ECoG were significantly higher in children with MCD compared with non-MCD (p = 0.018 and p = 0.002, respectively). Higher frequencies of EDs and ripple rates in preresection ECoG were observed in residual seizures than in seizure-free children (p = 0.045 and p = 0.005, respectively). Clinically, children with residual seizures after surgery were significantly younger at the onset, had a trend of higher seizure frequency and higher spike frequency of presurgical videoEEG. CONCLUSION Our results suggested that quantification of intraoperative ECoG predicted seizure outcomes and reflected different ED pattern and frequencies between MCD and non-dysplastic histopathology among children who underwent resective epileptic surgery. The results of our study were encouraging and indicated that intraoperative ECoG improved the outcomes of surgery in children with epilepsy.
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Affiliation(s)
- Syu-Jyun Peng
- Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Min-Lan Tsai
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yi-Shang Yang
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Long Chen
- Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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15
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Günbey C, Söylemezoğlu F, Bilginer B, Karlı Oğuz K, Akalan N, Topçu M, Turanlı G, Yalnızoğlu D. International consensus classification of hippocampal sclerosis and etiologic diversity in children with temporal lobectomy. Epilepsy Behav 2020; 112:107380. [PMID: 32882628 DOI: 10.1016/j.yebeh.2020.107380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The distribution of hippocampal sclerosis (HS) subtypes, according to the classification of the International League Against Epilepsy (ILAE), has been reported mainly in adult patients. We aimed to review the pathological findings in children who had anterior temporal lobectomy accompanied with amygdalohippocampectomy, in view of the current classification, and evaluate postsurgical outcome with respect to HS subtypes in childhood. METHODS Seventy children who underwent temporal resections for treatment of medically refractory epilepsy, with a minimum follow-up of 2 years, were included; the surgical hippocampus specimens were re-evaluated under the HS ILAE classification. RESULTS Neuropathological evaluations revealed HS type 1 in 38 patients (54.3%), HS type 2 in 2 (2.8%), HS type 3 in 21 patients (30%), and no HS in 9 patients (12.9%). Of 70 patients, 23 (32.9%) had dual pathology, and the most common pattern was HS type 3 with low-grade epilepsy-associated brain tumors (LEAT). The distribution of HS types with respect to age revealed that HS type 3 and no HS subgroups had significantly more patients younger than 12 years, compared with those of HS type 1 (90.5%, 77.8% vs 47.4%, respectively). History of febrile seizures was higher in HS type 1. Prolonged/recurrent febrile seizures were most common in patients 12 years and older, whereas LEAT was the most common etiology in patients under 12 years of age (p < 0.001). Patients with HS type 1 had longer duration of epilepsy and an older age at the time of surgery compared with patients with HS type 3 and no HS (p: 0.031, p: 0.007). At final visit, 74.3% of the patients were seizure-free. Seizure outcome showed no significant difference between pathological subtypes. CONCLUSIONS Our study presents the distribution of HS ILAE subtypes in an exclusively pediatric series along with long-term seizure outcome. The study reveals that the leading pathological HS subgroup in children is HS type 1, similar with adult series. Hippocampal sclerosis type 2 is significantly less in children compared with adults; however, HS type 3 emerges as the second most predominant group because of dual pathology, particularly LEAT. Further studies are required regarding clinicopathological features of isolated HS in pediatric cohort. Seizure-free outcome was favorable and similar in all HS types in children. The proportion of HS types may be better defined in pediatric patients with temporal resections, as the current HS ILAE classification becomes more widely used, and may help reveal the surgical and cognitive outcome with respect to HS types.
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Affiliation(s)
- Ceren Günbey
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Söylemezoğlu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burçak Bilginer
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kader Karlı Oğuz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nejat Akalan
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meral Topçu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güzide Turanlı
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yalnızoğlu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Sacino M, Huang SS, Alexander H, Fayed I, Keating RF, Oluigbo CO. An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery. Pediatr Neurosurg 2020; 55:141-148. [PMID: 32829333 DOI: 10.1159/000509329] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy. METHODS We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase® thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results. RESULTS Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be cost--effective. CONCLUSION Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery.
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Affiliation(s)
- Matthew Sacino
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - Sean S Huang
- Department of Health Systems Administration, Georgetown University, Washington, District of Columbia, USA
| | - Hepzibha Alexander
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Islam Fayed
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Robert F Keating
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA, .,Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA,
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Reinholdson J, Olsson I, Edelvik Tranberg A, Malmgren K. Long-term employment outcomes after epilepsy surgery in childhood. Neurology 2019; 94:e205-e216. [PMID: 31796526 PMCID: PMC6988983 DOI: 10.1212/wnl.0000000000008681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To analyze long-term employment outcomes in a population-based cohort of adults who underwent epilepsy surgery in childhood or adolescence and to compare the results to general population reference data. Methods Prospective data on epilepsy surgery procedures performed on patients <19 years of age between 1995 and 2012 were extracted from the Swedish National Epilepsy Surgery Register. Five-, 10-, 15- and 20-year follow-up data were analyzed. Patients aged ≥19 years at follow-up were eligible for inclusion. Educational attainment and employment status were analyzed in relation to seizure outcome. Education and employment outcomes of seizure-free patients with a preoperative IQ of ≥70 were compared to general population reference data. Results A total of 203 patients were included. The mean age at surgery was 13.6 years and 66% had IQ ≥70. Of these, a majority had attained at least high school education 5 years after surgery. Employment rates were 44%, 69%, 71%, and 77% at the 5-, 10-, 15-, and 20-year follow-ups, respectively. Seizure-free patients were significantly more likely to work full-time. Educational attainment and rates of full-time employment of seizure-free patients were similar to the general population. A majority of patients with IQ <70 had attended special education and were reliant on social benefits. Conclusion Long-term overall employment rates were higher compared to most previous studies on surgery in adults. Seizure-free patients with a preoperative IQ ≥70 showed rates of full-time employment similar to the general population. Further research is needed to determine whether this also applies for occupational complexity and wages.
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Affiliation(s)
- Jesper Reinholdson
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Ingrid Olsson
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Anna Edelvik Tranberg
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Kristina Malmgren
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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18
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Maschio M, Aguglia U, Avanzini G, Banfi P, Buttinelli C, Capovilla G, Casazza MML, Colicchio G, Coppola A, Costa C, Dainese F, Daniele O, De Simone R, Eoli M, Gasparini S, Giallonardo AT, La Neve A, Maialetti A, Mecarelli O, Melis M, Michelucci R, Paladin F, Pauletto G, Piccioli M, Quadri S, Ranzato F, Rossi R, Salmaggi A, Terenzi R, Tisei P, Villani F, Vitali P, Vivalda LC, Zaccara G, Zarabla A, Beghi E. Management of epilepsy in brain tumors. Neurol Sci 2019; 40:2217-2234. [PMID: 31392641 DOI: 10.1007/s10072-019-04025-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/20/2019] [Indexed: 12/15/2022]
Abstract
Epilepsy in brain tumors (BTE) may require medical attention for a variety of unique concerns: epileptic seizures, possible serious adverse effects of antineoplastic and antiepileptic drugs (AEDs), physical disability, and/or neurocognitive disturbances correlated to tumor site. Guidelines for the management of tumor-related epilepsies are lacking. Treatment is not standardized, and overall management might differ according to different specialists. The aim of this document was to provide directives on the procedures to be adopted for a correct diagnostic-therapeutic path of the patient with BTE, evaluating indications, risks, and benefits. A board comprising neurologists, epileptologists, neurophysiologists, neuroradiologists, neurosurgeons, neuro-oncologists, neuropsychologists, and patients' representatives was formed. The board converted diagnostic and therapeutic problems into seventeen questions. A literature search was performed in September-October 2017, and a total of 7827 unique records were retrieved, of which 148 constituted the core literature. There is no evidence that histological type or localization of the brain tumor affects the response to an AED. The board recommended to avoid enzyme-inducing antiepileptic drugs because of their interference with antitumoral drugs and consider as first-choice newer generation drugs (among them, levetiracetam, lamotrigine, and topiramate). Valproic acid should also be considered. Both short-term and long-term prophylaxes are not recommended in primary and metastatic brain tumors. Management of seizures in patients with BTE should be multidisciplinary. The panel evidenced conflicting or lacking data regarding the role of EEG, the choice of therapeutic strategy, and timing to withdraw AEDs and recommended high-quality long-term studies to standardize BTE care.
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Affiliation(s)
- Marta Maschio
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuliano Avanzini
- Department of Neurophysiology and Experimental Epileptology, Carlo Besta Neurological Institute, Milan, Italy
| | - Paola Banfi
- Neurology Unit, Department of Emergency, Medicine Epilepsy Center, Circolo Hospital, Varese, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Giuseppe Capovilla
- Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy
| | | | - Gabriella Colicchio
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Cinzia Costa
- Neurological Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Filippo Dainese
- Epilepsy Centre, UOC Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy
| | - Ornella Daniele
- Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Roberto De Simone
- Neurology and Stroke Unit, Epilepsy and Sleep Disorders Center, St. Eugenio Hospital, Rome, Italy
| | - Marica Eoli
- Molecular Neuro-Oncology Unit, IRCCS-Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Angela La Neve
- Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy
| | - Andrea Maialetti
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Oriano Mecarelli
- Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy
| | - Marta Melis
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Monserrato, Cagliari, Italy
| | - Roberto Michelucci
- Unit of Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Paladin
- Epilepsy Center, UOC Neurology, Ospedale Santi Giovanni e Paolo, Venice, Italy
| | - Giada Pauletto
- Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Stefano Quadri
- USC Neurology, Epilepsy Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Ranzato
- Epilepsy Centre, Neuroscience Department, S. Bortolo Hospital, Vicenza, Italy
| | - Rosario Rossi
- Neurology and Stroke Unit, San Francesco Hospital, 08100, Nuoro, Italy
| | | | - Riccardo Terenzi
- Epilepsy Consultation Room, Neurology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Paolo Tisei
- Neurophysiology Unit, Department of Neurology-University "La Sapienza", S. Andrea Hospital, Rome, Italy
| | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy
| | - Paolo Vitali
- Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Gaetano Zaccara
- Regional Health Agency of Tuscany, Via P Dazzi 1, 50141, Florence, Italy
| | - Alessia Zarabla
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Ettore Beghi
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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19
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Liu W, Tian S, Zhang J, Huang P, Wang T, Deng Y, Liu X, Miao F, Sun B, Zhan S. Utility of stereo-electroencephalography recording guided by magnetoencephalography in the surgical treatment of epilepsy patients with negative magnetic resonance imaging results. Int J Neurosci 2019; 129:1045-1052. [PMID: 31215295 DOI: 10.1080/00207454.2019.1634066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: It is challenging for neurosurgeons to perform surgeries on patients without detectable structural lesions. Therefore, this retrospective study aimed to explore the outcome of stereo-electroencephalography (SEEG) in suspicious areas guided by magnetoencephalography (MEG)-magnetic resonance imaging (MRI) reconstruction in MRI-negative epilepsy patients. Methods: This study included 47 patients with negative-MRI epilepsy. Seizure outcome at 24 months was assessed using a modified Engel's classification. Accordingly, class I and II were considered favorable outcomes, whereas classes III and IV were unfavorable. Furthermore, patients were classified into a consistent group if the results of MEG and SEEG indicated the same area of the brain. The relationship between surgical outcome and the concordance of MEG and SEEG was analyzed. Results: A complete seizure-free condition was achieved in 22 (47%) patients. Sex, handedness, age and duration of illness were not significantly associated with seizure-free outcome (p = .187 [Pearson chi-squared test]). The number of patients with favorable outcome (Engle I and II) was as high as 68% at the time of follow-up. Furthermore, more seizure-free patients were found in the SEEG and MEG consistent group. Conclusions: SEEG is a valuable tool in the pre-evaluation for resective epilepsy surgery, particularly in negative-MRI epilepsy patients; MEG greatly facilitates localization for SEEG electrode implantation. However, none of these tools are absolutely sensitive and reliable; therefore, collecting as much information as possible is necessary to achieve satisfactory results in epilepsy surgery.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shuaiwei Tian
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jing Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Peng Huang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yulei Deng
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaoying Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Fei Miao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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Arya R, Mangano FT, Horn PS, Kaul SK, Kaul SK, Roth C, Leach JL, Turner M, Holland KD, Greiner HM. Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter? J Neurosurg Pediatr 2019; 24:200-208. [PMID: 31151097 DOI: 10.3171/2019.4.peds18677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy. METHODS Children who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates. RESULTS One hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2-8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis. CONCLUSIONS A lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.
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Affiliation(s)
- Ravindra Arya
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.,2Department of Pediatrics, University of Cincinnati College of Medicine
| | | | - Paul S Horn
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Sabrina K Kaul
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Serena K Kaul
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Celie Roth
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - James L Leach
- 4Division of Pediatric Neuro-radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michele Turner
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - Katherine D Holland
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.,2Department of Pediatrics, University of Cincinnati College of Medicine
| | - Hansel M Greiner
- 1Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center.,2Department of Pediatrics, University of Cincinnati College of Medicine
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Puka K, Tavares TP, Speechley KN. Social outcomes for adults with a history of childhood-onset epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2019; 92:297-305. [PMID: 30731296 DOI: 10.1016/j.yebeh.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This review aimed to describe social outcomes in adulthood for people with a history of childhood-onset epilepsy and identify factors associated with these outcomes; focused on educational attainment, employment, income/financial status, independence/living arrangement, romantic relationships, parenthood, and friendships. METHODS A comprehensive search of MEDLINE, EMBASE, and PsycINFO was conducted, as well as forward and backward citation tracking. A total of 45 articles met inclusion criteria. Random effects meta-analyses were conducted, and subgroup analyses evaluated outcomes for people with epilepsy (PWE) with good prognosis (e.g., normal intelligence, 'epilepsy-only') and poor prognosis (e.g., intellectual disability, Dravet syndrome), and those who underwent epilepsy surgery in childhood. RESULTS Among all PWE, 73% (95% confidence interval [CI]: 64-82%) completed secondary school education, 63% (95%CI: 56-70%) were employed; 74% (95%CI: 68-81%) did not receive governmental financial assistance; 32% (95%CI: 25-39%) were in romantic relationships; 34% (95%CI: 24-45%) lived independently; 21% (95%CI:12-33%) had children, and 79% (95%CI: 71-87%) had close friend(s). People with epilepsy often fared worse relative to healthy controls. Among PWE with a good prognosis, a comparable number of studies reported similar/better outcomes relative to controls as reported poorer outcomes. The most consistent predictor of poorer outcomes was the presence of cognitive problems; results of studies evaluating seizure control were equivocal. CONCLUSION People with epilepsy with a good prognosis may show similar social outcomes as controls, though robust conclusions are difficult to make given the extant literature. Seizure control does not guarantee better outcomes. There is a need for more studies evaluating prognostic factors and studies with control groups to facilitate appropriate comparisons.
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Affiliation(s)
- Klajdi Puka
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Tamara P Tavares
- Department of Neuroscience, Western University, London, ON, Canada; Brain and Mind Institute, Western University, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Department of Paediatrics, Western University, London, ON, Canada
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22
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Chen C, Li H, Ding F, Yang L, Huang P, Wang S, Jin B, Xu C, Wang Y, Ding M, Chen Z, Wang S. Alterations in the hippocampal-thalamic pathway underlying secondarily generalized tonic-clonic seizures in mesial temporal lobe epilepsy: A diffusion tensor imaging study. Epilepsia 2018; 60:121-130. [PMID: 30478929 DOI: 10.1111/epi.14614] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Cong Chen
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Hong Li
- Department of Radiology; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Fang Ding
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Linglin Yang
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Peiyu Huang
- Department of Radiology; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Shan Wang
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Bo Jin
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Cenglin Xu
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology; Department of Pharmacology; College of Pharmaceutical Sciences; Zhejiang University; Hangzhou China
| | - Yi Wang
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology; Department of Pharmacology; College of Pharmaceutical Sciences; Zhejiang University; Hangzhou China
| | - Meiping Ding
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - Zhong Chen
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology; Department of Pharmacology; College of Pharmaceutical Sciences; Zhejiang University; Hangzhou China
| | - Shuang Wang
- Department of Neurology; Epilepsy Center; Second Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
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Mansouri A, Taslimi S, Abbasian A, Badhiwala JH, Akbar MA, Alotaibi NM, Almenawer SA, Weil AG, Fallah A, Carmant L, Ibrahim GM. Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: a systematic review and meta-analysis. J Neurosurg 2018; 131:1068-1078. [PMID: 30497170 DOI: 10.3171/2018.5.jns18599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/29/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs). METHODS The MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported. RESULTS Twenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%-82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%-85%). CONCLUSIONS Surgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.
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Affiliation(s)
- Alireza Mansouri
- 1Department of Neuro-Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Aria Fallah
- 6Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, California; and
| | - Lionel Carmant
- 7Division of Neurology, CHU Sainte-Justine Hospital, University of Montreal, Quebec, Canada
- 8Clinique d'Epilepsie de Port-au-Prince, Haiti
| | - George M Ibrahim
- 9Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario
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Elliott CA, Broad A, Narvacan K, Steve TA, Snyder T, Urlacher J, Wheatley BM, Sinclair DB. Seizure outcome in pediatric medically refractory temporal lobe epilepsy surgery: selective amygdalohippocampectomy versus anterior temporal lobectomy. J Neurosurg Pediatr 2018; 22:276-282. [PMID: 29932370 DOI: 10.3171/2018.4.peds17607] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate long-term seizure outcome, rate of reoperation, and postoperative neuropsychological performance following selective amygdalohippocampectomy (SelAH) or anterior temporal lobectomy (ATL) in pediatric patients with medically refractory temporal lobe epilepsy (TLE). METHODS The authors performed a retrospective review of cases of medically refractory pediatric TLE treated initially with either SelAH or ATL. Standardized pre- and postoperative evaluation included seizure charting, surface and long-term video-electroencephalography, 1.5-T MRI, and neuropsychological testing. RESULTS A total of 79 patients treated initially with SelAH (n = 18) or ATL (n = 61) were included in this study, with a mean follow-up of 5.3 ± 4 years (range 1-16 years). The patients' average age at initial surgery was 10.6 ± 5 years, with an average surgical delay of 5.7 ± 4 years between seizure onset and surgery. Seizure freedom (Engel I) following the initial operation was significantly more likely following ATL (47/61, 77%) than SelAH (8/18, 44%; p = 0.017, Fisher's exact test). There was no statistically significant difference in the proportion of patients with postoperative neuropsychological deficits following SelAH (8/18, 44%) or ATL (21/61, 34%). However, reoperation was significantly more likely following SelAH (8/18, 44%) than after ATL (7/61, 11%; p = 0.004) and was more likely to result in Engel I outcome for ATL after failed SelAH (7/8, 88%) than for posterior extension after failed ATL (1/7, 14%; p = 0.01). Reoperation was well tolerated without significant neuropsychological deterioration. Ultimately, including 15 reoperations, 58 of 79 (73%) patients were free from disabling seizures at the most recent follow-up. CONCLUSIONS SelAH among pediatric patients with medically refractory unilateral TLE yields significantly worse rates of seizure control compared with ATL. Reoperation is significantly more likely following SelAH, is not associated with incremental neuropsychological deterioration, and frequently results in freedom from disabling seizures. These results are significant in that they argue against using SelAH for pediatric TLE surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - D Barry Sinclair
- 4Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
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25
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Meng Y, Voisin MR, Suppiah S, Merali Z, Moghaddamjou A, Alotaibi NM, Manicat-Emo A, Weiss S, Go C, McCoy B, Donner EJ, Rutka JT. Risk factors for surgical site infection after intracranial electroencephalography monitoring for epilepsy in the pediatric population. J Neurosurg Pediatr 2018; 22:31-36. [PMID: 29624147 DOI: 10.3171/2018.1.peds17476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial electroencephalography (iEEG) monitoring is an important method of identifying the seizure focus in patients with medically refractory epilepsy. While previous studies have demonstrated low rates of surgical complications, reported rates of surgical site infection (SSI) are highly variable. To date, no studies have specifically evaluated the patient or operative risk factors contributing to SSI. The goals of this study were to examine the rate of SSI after iEEG monitoring for epilepsy workup in pediatric patients and to determine the variables that might contribute to the development of SSI. METHODS A retrospective analysis of hospital charts at the Hospital for Sick Children was performed for all patients who had undergone iEEG monitoring between 2000 and 2016. Univariate and multivariate analyses were performed to look for statistically significant variables in relation to SSI. RESULTS Among 199 patients eligible for analysis, 8 (4.0%) developed SSIs within a period ranging from 21 to 51 days postoperatively. Univariate analysis yielded 4 factors related to SSI: number of people present in the operating room on electrode insertion (p = 0.02), length of insertion surgery (p = 0.04), previous operation at the same surgical site (p = 0.04), and number of depth electrodes inserted (p = 0.01). Multivariate analysis revealed that both the number of people present during the implant operation (OR 0.08, 95% CI 0.01-0.70) and the number of depth electrodes inserted (OR 3.52, 95% CI 1.44-8.59) independently contributed to SSI. CONCLUSIONS This is the largest case series and the first comprehensive review of both patient and operative risk factors in the development of SSI from iEEG monitoring in a pediatric population. The authors' institution had a lower rate of infection than those in most other studies, which could be explained by their protocol of administering intravenous antibiotics perioperatively and post-implant removal antibiotics for 14 days. The authors found a correlation between SSI and the number of people present during the implant operation, as well as the number of depth electrodes; both may contribute to breaks in sterility.
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Affiliation(s)
- Ying Meng
- 1Division of Neurosurgery, University of Toronto; and
| | | | | | - Zamir Merali
- 1Division of Neurosurgery, University of Toronto; and
| | | | | | | | | | | | | | | | - James T Rutka
- 1Division of Neurosurgery, University of Toronto; and.,3Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Prideaux L, Barton S, Maixner W, Harvey AS. Potential delays in referral and assessment for epilepsy surgery in children with drug-resistant, early-onset epilepsy. Epilepsy Res 2018; 143:20-26. [PMID: 29631130 DOI: 10.1016/j.eplepsyres.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/17/2018] [Accepted: 04/02/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To study potential delays in epilepsy surgery in children with drug-resistant epilepsy (DRE) of early-onset. METHODS Medical records were reviewed from 87 children with DRE and seizure onset before age 3 years who underwent epilepsy surgery between 2006 and 2015. Information was obtained about each child's epilepsy, treatment and specific time points in management. Time intervals along diagnostic, investigative, treatment and referral pathways were calculated. RESULTS Median ages at seizure onset, when seen in the epilepsy surgery program and surgery were 5.9 (IQR 10), 19 (IQR 29) and 36 (IQR 67) months; the median delay from seizure onset to surgery was 30 (IQR 67) months. Most children were promptly diagnosed, treated, investigated and seen by a pediatric neurologist. Focal abnormalities were reported on initial EEGs and MRIs in most children, and DRE developed within a median of 6.3 months from commencement of medication. There were median durations of 6.2 months between seeing a neurologist and being seen in the epilepsy surgery program, and then 6.1 months in determining surgical candidacy. Median durations from potential indications for a surgical evaluation to agreed surgical candidacy were 10 (DRE), 12 (focal MRI) and 17 (focal EEG) months. Children received a median of six antiepileptic drugs prior to surgery. Median interval from agreed surgical candidacy to surgery was only 3 months. There were longer durations from seizure onset to surgery in children needing PET (p = 0.001) and in children with seizure-free periods (p < 0.001), and shorter durations in children with a history of infantile spasms (p = 0.01). SIGNIFICANCE Delays in referral of children for epilepsy surgery are reported. Delays in assessment may be specific to centralized children's hospitals in public health systems.
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Affiliation(s)
- Laura Prideaux
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Sarah Barton
- Neurosciences, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Department of Neurology, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Wirginia Maixner
- Neurosciences, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Department of Neurosurgery, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - A Simon Harvey
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia; Neurosciences, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Department of Neurology, The Royal Children's Hospital, Parkville, VIC 3052, Australia.
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27
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Benifla M, Bennet-Back O, Shorer Z, Noyman I, Bar-Yosef R, Ekstein D. Temporal lobe surgery for intractable epilepsy in children: What to do with the hippocampus? Seizure 2017; 52:81-88. [PMID: 29017082 DOI: 10.1016/j.seizure.2017.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/07/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Resection of the hippocampus can cause verbal memory decline, especially in the pediatric population. Thus, preservation of the hippocampus can be crucial for the quality of life of children with intractable temporal lobe epilepsy (TLE) who are candidates for epilepsy surgery. We investigated techniques that determine whether the hippocampus is part of the epileptogenic zone and the outcomes of pediatric surgery aimed to spare the hippocampus. METHODS We accessed data of children with normal hippocampus on MRI, who underwent surgery for medically refractory TLE. To identify epileptogenic areas, electrocorticography was performed in patients with space occupying lesions adjacent to the hippocampus, and long term invasive monitoring in patients with nonlesional TLE. Postoperative seizure control was classified according to Engel I-IV; Class I indicates seizure-free. RESULTS Eleven females and 11 males met study inclusion criteria; the mean age at surgery was 11.3 years. Cortical and hippocampal electrocorticography was performed in 15 patients and long term invasive hippocampal monitoring in seven. The hippocampus was preserved in 16 patients (73%) while hippocampectomy was performed in 6 (27%). At the end of a mean follow-up of 3.5 years, 94% (15/16) of the patients who did not undergo hippocampectomy were classified as Engel I, compared to 50% (3/6) who underwent hippocampectomy. CONCLUSION Sparing the hippocampus in temporal lobe epilepsy surgery is possible with excellent seizure outcome, while using the proper intraoperative technique.
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Affiliation(s)
- Mony Benifla
- The Neurosurgical Pediatric Unit, Rambam Health Care Campus, Haifa, Israel.
| | - Odeya Bennet-Back
- Pediatric Neurology Department, Shaare-Zedek Medical Center, Jerusalem, Israel.
| | - Zamir Shorer
- Pediatric Neurology Department, Soroka Medical Center, Beer-Sheva, Israel.
| | - Iris Noyman
- Pediatric Neurology Department, Soroka Medical Center, Beer-Sheva, Israel.
| | - Rima Bar-Yosef
- Neurology Department, Agnes Ginges Center for Human Neurogenetics, Hadassah Medical Center, Jerusalem, Israel.
| | - Dana Ekstein
- Neurology Department, Agnes Ginges Center for Human Neurogenetics, Hadassah Medical Center, Jerusalem, Israel.
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Neuropsychological outcomes following paediatric temporal lobe surgery for epilepsies: Evidence from a systematic review. Seizure 2017; 52:89-116. [PMID: 29032016 DOI: 10.1016/j.seizure.2017.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The systematic review aimed to assess the neuropsychological outcomes of temporal lobe resections for epilepsy in children. Additional objectives included determining whether earlier age at surgery leads to better neuropsychological outcomes; the relationships between and predictors of these outcomes. METHODS Using advanced search terms, a systematic review of electronic databases was conducted, comprising MEDLINE, Embase, PsycINFO, Global Health, Web of Science and CINAHL. Included studies reported on outcome following neurosurgical treatment for epilepsy. Specifically, studies were included if they reported neuropsychological outcomes and were concerned only with temporal lobe resection. RESULTS 73 studies met inclusion criteria. For reported neuropsychological outcomes, the majority of participants remained stable after surgery; some declined and some improved. There was some evidence for increased material-specific memory deficits after temporal lobe surgery based on resection side, and more positive cognitive outcome for those with lower pre-surgical ability level. SIGNIFICANCE Retrieved evidence highlights the need for improvements to quality of methodology and reporting. Appropriately designed prospective multicentre trials should be conducted with adequate follow-up for long-term outcomes to be measured. Core outcome measures should be agreed between centres. This would permit higher quality evidence so that clinicians, young people and their families may make better informed decisions about whether or not to proceed with surgery and likely post-operative profile.
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Ehrstedt C, Moreira NC, Casar-Borota O, Strömberg B, Ahlsten G. Glioneuronal tumors in childhood - Before and after surgery. A long-term follow-up study. Epilepsy Behav 2017; 72:82-88. [PMID: 28575773 DOI: 10.1016/j.yebeh.2017.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
AIM To give a detailed description of the long-term outcome of a cohort of children with glioneuronal tumors regarding pre- and postsurgical factors, including "dual" and "double" pathology, seizure freedom, and psychosocial outcome. METHODS During a fifteen-year period (1995-2009), all patients (age 0-17.99years) with a glioneuronal brain tumor diagnosed and treated at Uppsala University Children's Hospital were identified from the National Brain Tumor Registry and the National Epilepsy Surgery Registry. Hospital medical records were reviewed and neuroradiological and neuropathological findings were re-evaluated. A cross-sectional long-term follow-up prospective evaluation, including an interview, neurologic examination, and electroencephalogram, was accomplished in patients accepting participants in the study. RESULTS A total of 25 out of 28 (89%) eligible patients were included. The M:F ratio was 1.5:1. Mean follow-up time after surgery was 12.1years (range 5.0-19.3). Twenty patients were adults (>18years) at follow-up. Seizure freedom was achieved in 64%. Gross total resection (GTR) was the only preoperative factor significantly correlating to seizure freedom (p=0.027). Thirty-eight percent were at some time postoperatively admitted for a psychiatric evaluation. There was a trend towards both higher educational level and employment status in adults who became seizure free. CONCLUSION Long-term outcome is good regarding seizure freedom if GTR can be achieved, but late seizure recurrence can occur. "Dual" and "double" pathology is uncommon and does not influence seizure outcome. Obtaining seizure freedom seems to be important for psychosocial outcome, but there is a risk for psychiatric comorbidities and long-term follow-up by a multi-professional team is advisable.
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Affiliation(s)
- Christoffer Ehrstedt
- Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Uppsala University Children's Hospital, Uppsala, Sweden.
| | - Nuno Canto Moreira
- Department of Imaging and Function, Neuroradiology Section, Uppsala University Hospital, Uppsala, Sweden
| | - Olivera Casar-Borota
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Clinical Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden
| | - Bo Strömberg
- Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Uppsala University Children's Hospital, Uppsala, Sweden
| | - Gunnar Ahlsten
- Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Uppsala University Children's Hospital, Uppsala, Sweden
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Bansal S, Kim AJ, Berg AT, Koh S, Laux LC, Nangia S, Millichap JJ, Shaw A, Fisher B, Dezort C, DiPatri AJ, Alden TD, Nordli DR. Seizure Outcomes in Children Following Electrocorticography-Guided Single-Stage Surgical Resection. Pediatr Neurol 2017; 71:35-42. [PMID: 28483395 DOI: 10.1016/j.pediatrneurol.2017.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/13/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND In children with abnormal imaging, single-stage epilepsy surgery is an attractive alternative to the two-stage approach that relies on invasive recording of seizures. Implanted electrodes carry risks of their own and extend hospitalization, but the efficacy of one-stage resections in a variety of pathologies and cerebral locations is not well established. We report our center's experience with single-stage epilepsy surgery guided by intraoperative electrocorticography (ECoG). METHODS We retrospectively analyzed 130 consecutive patients who underwent single-stage epilepsy surgery before age 19 years and had at least a two-year follow-up. Intraoperative ECoG was available for review in 113. Patients were considered seizure-free if they were continuously Engel Class I up to the two-year postoperative mark. ECoG findings were classified according to the presence of interictal attenuation, spikes, both, or neither. Complications and hospital length of stay were evaluated. RESULTS Eighty percent of 130 patients were seizure-free at two years. All but one had an abnormal MRI. Patients with tumor had a better seizure outcome than patients with cortical malformation. Frontal resections had worse outcome, especially among tumors. Intraoperative ECoG revealed both attenuation and spikes in 48%, attenuation only in 23%, spikes only in 20%, and neither in 9%. The complication rate was 6.9%, with no major neurological complications. The average length of stay was 5.7 nights. CONCLUSIONS With ECoG-guided single-stage surgery, we achieved results comparable with other pediatric surgical series and with a low complication rate. An extensive two-stage approach may not be required when there is a lesion on imaging and other information is concordant, even when the MRI abnormality is subtle and unclearly delineated. Frontal foci may present a challenge because of their proximity to "eloquent" nonresectable cortex or critical structures.
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Affiliation(s)
- Seema Bansal
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew J Kim
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Anne T Berg
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sookyong Koh
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Linda C Laux
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Srishti Nangia
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John J Millichap
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandra Shaw
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Breanne Fisher
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine Dezort
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Arthur J DiPatri
- Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tord D Alden
- Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Douglas R Nordli
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Hosoyama H, Matsuda K, Mihara T, Usui N, Baba K, Inoue Y, Tottori T, Otsubo T, Kashida Y, Iida K, Hirano H, Hanaya R, Arita K. Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey. J Neurosurg Pediatr 2017; 19:606-615. [PMID: 28291425 DOI: 10.3171/2016.12.peds16197] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier. METHODS Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe. RESULTS For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome. CONCLUSIONS The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.
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Affiliation(s)
- Hiroshi Hosoyama
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Kazumi Matsuda
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Tadahiro Mihara
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Naotaka Usui
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Koichi Baba
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Yushi Inoue
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Takayasu Tottori
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Toshiaki Otsubo
- Department of Neurosurgery, Fujimoto General Hospital, Miyakonojo, Miyazaki; and
| | - Yumi Kashida
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Hirano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
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Puka K, Smith ML. Where are they now? Psychosocial, educational, and vocational outcomes after epilepsy surgery in childhood. Epilepsia 2016; 57:574-81. [DOI: 10.1111/epi.13327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Klajdi Puka
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; University of Toronto Mississauga; Mississauga Ontario Canada
- Neurosciences and Mental Health Program; The Hospital for Sick Children; Toronto Ontario Canada
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Stanišić M, Coello C, Ivanović J, Egge A, Danfors T, Hald J, Heminghyt E, Mikkelsen MM, Krossnes BK, Pripp AH, Larsson PG. Seizure outcomes in relation to the extent of resection of the perifocal fluorodeoxyglucose and flumazenil PET abnormalities in anteromedial temporal lobectomy. Acta Neurochir (Wien) 2015; 157:1905-16. [PMID: 26350516 PMCID: PMC4604506 DOI: 10.1007/s00701-015-2578-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/06/2015] [Indexed: 11/28/2022]
Abstract
Background The area of predominant perifocal [18F]fluorodeoxyglucose (18F-FDG) hypometabolism and reduced [11C]flumazenil (11C-FMZ) -binding on PET scans is currently considered to contain the epileptogenic zone and corresponds anatomically to the area localizing epileptogenicity in patients with temporal lobe epilepsy (TLE). The question is whether the volume of the perifocal pre-operative PET abnormalities, the extent of their resection, and the volume of the non-resected abnormalities affects the post-operative seizure outcome. Methods The sample group consisted of 32 patients with mesial temporal sclerosis who underwent anteromedial temporal lobe resection for refractory TLE. All patients had pathologic perifocal findings on both of the PET modalities as well as on the whole-brain MRI. The volumetric data of the PET and MRI abnormalities within the resected temporal lobe were estimated by automated quantitative voxel-based analysis. The obtained volumetric data were investigated in relation to the outcome subgroups of patients (Engel classification) determined at the 2-year post-operative follow-up. Results The mean volume of the pre-operative perifocal 18F-FDG- and 11C-FMZ PET abnormalities in the volumes of interest (VOI) of the epileptogenic temporal lobe, the mean resected volume of these PET abnormalities, the mean volume of the non-resected PET abnormalities, and the mean MRI-derived resected volume were not significantly related to the outcome subgroups and had a low prediction for individual freedom from seizures. Conclusions The extent of pre-surgical perifocal PET abnormalities, the extent of their resection, and the extent of non-resected abnormalities were not useful predictors of individual freedom from seizures in patients with TLE.
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Affiliation(s)
- Milo Stanišić
- Department of Neurosurgery Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway.
| | | | - Jugoslav Ivanović
- Department of Neurosurgery Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway
| | - Arild Egge
- Department of Neurosurgery Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway
| | - Torsten Danfors
- Section of Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - John Hald
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Einar Heminghyt
- Department of Clinical Psychology and Neuropsychology, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Marjan Makki Mikkelsen
- Department of Adult Epilepsy, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Center of Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Pål Gunnar Larsson
- Clinical Neurophysiologic Laboratories, Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Employability in people with epilepsy: A systematic review. Epilepsy Res 2015; 116:67-78. [DOI: 10.1016/j.eplepsyres.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 11/20/2022]
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Seizure outcomes in children with epilepsy after resective brain surgery. Eur J Paediatr Neurol 2015; 19:577-83. [PMID: 26095098 DOI: 10.1016/j.ejpn.2015.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 04/25/2015] [Accepted: 05/27/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the role of resective brain surgery in childhood epilepsy. METHODOLOGY We retrospectively analysed the seizure outcomes in 55 children with epilepsy who had resective brain surgery between 1997 and 2012, at our centre. The children were 1.5-18 years at the time of surgery; their seizure onset was between 0.2 andto 15 years of age. 48 had refractory epilepsy. One child died of tumour progression. Follow-up duration in the survivors ranged from 2 to -16 years (mean: 9).Presurgical evaluation included clinical profiles, non-invasive V-EEG monitoring, neuroimaging with MRIs in all; SPECT and PET in selected patients. 54 had intraoperative ECoG. RESULTS An Engel Class 1 outcome was seen in 78% of the cohort, with 67% being off all AEDs at the most recent follow-up. Children with tumours constituted the majority (56%), with 87% of this group showing a Class 1 outcome and 84% being off AEDs. Children with cortical dysplasia had a Class 1 outcome in 56%. CONCLUSION Resective brain surgery is an efficacious option in some children with epilepsy. We found ECoG useful to tailor the cortical resection and in our opinion ECoG contributed to the good seizure outcomes.
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Wessling C, Bartels S, Sassen R, Schoene-Bake JC, von Lehe M. Brain tumors in children with refractory seizures—a long-term follow-up study after epilepsy surgery. Childs Nerv Syst 2015. [PMID: 26201552 DOI: 10.1007/s00381-015-2825-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Epilepsy surgery is an established treatment option for medically refractory epilepsy. Brain tumors, besides dysplasias, vascular malformations, and other lesions, can cause refractory epilepsy. Long-term epilepsy-associated brain tumors, even though mostly benign, are neoplastic lesions and thus have to be considered as both epileptic and oncological lesions. METHODS We retrospectively analyzed epileptological and oncological long-term follow-up (FU) in pediatric patients who underwent brain surgery for refractory epilepsy and whose histology showed a tumor as underlying cause (n = 107, mean FU 119 months). RESULTS At last available outcome, 82.2% of patients were seizure free (International League Against Epilepsy (ILAE) class 1) and seizure outcome was stable over more than 14 years. Fifty-four percent of the patients were without anti-epileptic drugs (AEDs) at last available outcome; 96.2% of the tumors were classified WHO grade I and II and 3.7% were malignant (WHO grade III). Adjuvant treatment was administered in 5.7%; 2.9% had relapse and one patient died (tumor-related mortality = 1.4%). After surgery, 91% of the patients attended regular school/university and/or professional training. CONCLUSIONS This study shows that epileptological outcome within this group is promising and stable and oncological outcome has a very good prognosis. However, oncological FU must not be dismissed as a small percentage of patients who suffer from malignant tumors and adjuvant treatment, relapse, and mortality have to be considered.
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Affiliation(s)
- Caroline Wessling
- Department of Neurosurgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany,
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Bower RS, Wirrell EC, Eckel LJ, Wong-Kisiel LC, Nickels KC, Wetjen NM. Repeat resective surgery in complex pediatric refractory epilepsy: lessons learned. J Neurosurg Pediatr 2015; 16:94-100. [PMID: 25910035 DOI: 10.3171/2014.12.peds14150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Resection can sometimes offer the best chance of meaningful seizure reduction in children with medically intractable epilepsy. However, when surgery fails to achieve the desired outcome, reoperation may be an option. The authors sought to investigate outcomes following resective reoperation in pediatric patients with refractory epilepsy, excluding tumoral epilepsies. Differences in preoperative workup between surgeries are analyzed to identify factors influencing outcomes and complications in this complex group. METHODS Medical records were reviewed for all pediatric patients undergoing a repeat resective surgery for refractory epilepsy at the authors' institution between 2005 and 2012. Tumor and vascular etiologies were excluded. Preoperative evaluation and outcomes were analyzed for each surgery and compared. RESULTS Ten patients met all inclusion criteria. The median age at seizure onset was 4.5 months. Preoperative MRI revealed no lesion in 30%. Nonspecific gliosis and cortical dysplasia were the most common pathologies. The majority of preoperative workups included MRI, video-electroencephalography (EEG), and SISCOM. Intracranial EEG was performed for 60% for the first presurgical evaluation and 70% for the second evaluation. The goal of surgery was palliative in 4 patients with widespread cortical dysplasia. The final Engel outcome was Class I in 50%. The rate of favorable outcome (Engel Class I-II) was 70%. The complication rate for the initial surgery was 10%. However, the rate increased to 50% with the second surgery, and 3 of these 5 complications were pseudomeningoceles requiring shunt placement (2 of the 3 patients underwent hemispherotomy). CONCLUSIONS Resective reoperation for pediatric refractory epilepsy has a high rate of favorable outcome and should be considered in appropriate candidates, even as a palliative measure. Intracranial EEG monitoring should be considered on initial workup in cases where the results of imaging or EEG studies are ambiguous or conflicting. Epilepsy secondary to cortical dysplasia, especially if the dysplasia is not seen clearly on MRI, can be difficult to cure surgically. Therefore, in these cases, as large a resection as can be safely accomplished should be done, particularly when the goal is palliative. The rate of complications, particularly pseudomeningocele ultimately requiring shunt placement, is much higher following reoperation, and patients should be counseled accordingly.
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Affiliation(s)
| | | | - Laurence J Eckel
- Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Shah R, Botre A, Udani V. Trends in pediatric epilepsy surgery. Indian J Pediatr 2015; 82:277-85. [PMID: 25646596 DOI: 10.1007/s12098-014-1660-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/04/2014] [Indexed: 02/03/2023]
Abstract
Epilepsy surgery has become an accepted treatment for drug resistant epilepsy in infants and children. It has gained ground in India over the last decade. Certain epilepsy surgically remediable syndromes have been delineated and should be offered surgery earlier rather than later, especially if cognitive/behavioral development is being compromised. Advances in imaging, particularly in MRI has helped identify surgical candidates. Pre-surgical evaluation includes clinical assessment, structural and functional imaging, inter-ictal EEG, simultaneous video -EEG, with analysis of seizure semiology and ictal EEG and other optional investigations like neuropsychology and other newer imaging techniques. If data are concordant resective surgery is offered, keeping in mind preservation of eloquent cortical areas subserving motor, language and visual functions. In case of discordant data or non-lesional MRI, invasive EEG maybe useful using a two-stage approach. With multi-focal / generalized disease, palliative surgery like corpus callosotomy and vagal nerve stimulation maybe useful. A good outcome is seen in about 2/3rd of patients undergoing resective surgery with a low morbidity and mortality. This review outlines important learning aspects of pediatric epilepsy surgery for the general pediatrician.
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Affiliation(s)
- Ritesh Shah
- Department of Pediatric Neurology, New Civil Hospital, Surat, India
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Zuccato JA, Milburn C, Valiante TA. Balancing health literacy about epilepsy surgery in the community. Epilepsia 2014; 55:1754-62. [DOI: 10.1111/epi.12791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey A. Zuccato
- Faculty of Medicine; Institute of Medical Science; University of Toronto; Toronto Ontario Canada
- Division of Neurosurgery; Department of Surgery; University of Toronto; Toronto Ontario Canada
| | | | - Taufik A. Valiante
- Faculty of Medicine; Institute of Medical Science; University of Toronto; Toronto Ontario Canada
- Division of Neurosurgery; Department of Surgery; University of Toronto; Toronto Ontario Canada
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Cross JH, Duchowny M. Transition in lesional focal epilepsy, and following epilepsy surgery. Epilepsia 2014; 55 Suppl 3:34-6. [DOI: 10.1111/epi.12705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J. Helen Cross
- UCL-Institute of Child Health; Great Ormond Street Hospital for Children NHS Foundation Trust; London & Young Epilepsy; Lingfield United Kingdom
| | - Michael Duchowny
- Department of Neurology; Brain Institute; Miami Children's Hospital; University of Miami Leonard Miller School of Medicine; Miami Florida U.S.A
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Ramantani G, Strobl K, Stathi A, Brandt A, Schubert-Bast S, Wiegand G, Korinthenberg R, Stephani U, van Velthoven V, Zentner J, Schulze-Bonhage A, Bast T. Reoperation for refractory epilepsy in childhood: a second chance for selected patients. Neurosurgery 2014; 73:695-704; discussion 704. [PMID: 23842559 DOI: 10.1227/neu.0000000000000081] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reoperations account for >10% in pediatric epilepsy surgery cohorts, and they are especially relevant in young children with catastrophic epilepsy. OBJECTIVE To determine surgical outcomes and their predictive factors in reoperations for refractory epilepsy in childhood. METHODS We retrospectively analyzed presurgical findings, resections, and outcomes of 23 consecutive children who underwent reoperations from 2000 to 2011. RESULTS Etiology included cortical dysplasia with/without glioneuronal tumor in 19 patients (83%), sole glioneuronal tumor in 2, and tuberous sclerosis and Rasmussen encephalitis in 1 each. The reasons for the failure of the initial surgery were functional considerations in 8 (35%), incorrect delineation of the epileptogenic zone in 8 (35%), and resection not performed as initially planned in 7 (30%) cases. Final procedures included 8 (35%) intralobar, 8 (35%) multilobar resections, and 7 (30%) hemispherotomies. Following reoperations, 14 (61%) patients were seizure free, 6 (26%) showed significant or worthwhile improvement, and 3 (13%) did not respond to surgery. Six of 8 patients who underwent the first resection before the age of 3 years, 6 of 8 whose first resection was limited by functional considerations, and all 7 with hemispherotomy as the final resection achieved seizure freedom after reoperation. CONCLUSION Reoperation is particularly beneficial for selected children with refractory epilepsy associated with cortical dysplasia that did not respond to an initial limited and/or early resection but achieved seizure freedom after extensive procedures. When indicated, reoperation should be performed at the youngest possible age to profit from higher functional plasticity in compensating for neurological deficit.
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Affiliation(s)
- Georgia Ramantani
- *Epilepsy Center, University Hospital Freiburg, Freiburg, Germany; ‡Epilepsy Center Kork, Kehl-Kork, Germany; §Department of General Pediatrics, University Children's Hospital Heidelberg, Germany; ‖Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany; ¶Department of Neuropediatrics and Muscular Disorders, University Children's Hospital Freiburg, Freiburg, Germany; #Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Marras CE, Canevini MP, Colicchio G, Guerrini R, Rubboli G, Scerrati M, Spreafico R, Tassi L, LoRusso G, Tinuper P. Health Technology Assessment report on the presurgical evaluation and surgical treatment of drug-resistant epilepsy. Epilepsia 2013; 54 Suppl 7:49-58. [PMID: 24099055 DOI: 10.1111/epi.12309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Epilepsy is a neurologic disorder with major social impact. Surgery is a valuable option in patients who are not responding to antiepileptic drugs. The literature reports demonstrate that a proportion ranging from 40 to 100% of patients with epilepsy achieve seizure remission after surgery. A presurgical evaluation (clinical and instrumental) must be performed in all patients with drug-resistant epilepsy to assess their suitability for surgical intervention. Health Technology Assessment (HTA) represents a modern approach to the analysis of technologies used for health care. HTA could be considered a bridge between science that produces evidence and the decisions that can be taken on the basis of that evidence at different levels of the health care system. The aim of this study is the HTA of epilepsy surgery including clinical, ethical, social, and economic features. METHODS The present study includes an analysis of the diagnostic and surgical workup performed at the Italian centers for the diagnosis and treatment of drug-resistant epilepsy (DRE). The study includes the following issues: (1) social, ethical impact, and costs of the disease; (2) clinical results, efficacy, and safety of surgery; (3) ethics and quality of life after surgery; and (4) economic impact and productivity regained after surgery. The cost of managing a patient with DRE included in the presurgical study was estimated by the bottom-up microcosting technique that starts from a detailed collection of data on consumption of resources and full costing. The phases analyzed were (1) noninvasive diagnostic workup; (2) neurosurgical intervention; and (3) follow-up. KEY FINDINGS The literature reports indicate epilepsy surgery as an effective treatment both on clinical results and on ethical, social, and quality of life aspects. The workup including the noninvasive presurgical study followed by surgery has a total cost of €20,827. Management of short-term follow-up increases the overhead to €22,291 at the first year, and then to €23,571 after 5 years. According to the estimates made in this survey, funding based on diagnosis-related group (DRG) tariff for the noninvasive diagnostic stage involving hospital admission is not remunerative in Italy either at regional or national levels. Effectively the difference between full cost and DRG has a delta of €3,402 and €2,537 respectively. The total cost of the presurgical, surgical, and follow-up evaluation is not remunerative for €10,554 (national data). SIGNIFICANCE Economic surveys in Italy have shown that surgery for DRE is an advantageous treatment from the standpoint of third-party payers and is cost-effective for society. DRE presurgical evaluation and surgery are not remunerative either at regional or national levels.
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Affiliation(s)
- Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children Hospital, Rome, Italy
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Perry MS, Duchowny M. Surgical versus medical treatment for refractory epilepsy: Outcomes beyond seizure control. Epilepsia 2013; 54:2060-70. [DOI: 10.1111/epi.12427] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Scott Perry
- Comprehensive Epilepsy Program; Jane and John Justin Neuroscience Center; Cook Children's Medical Center; Fort Worth Texas U.S.A
| | - Michael Duchowny
- Department of Neurology and Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
- Department of Neurology; University of Miami Leonard Miller School of Medicine; Miami Florida U.S.A
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Hallböök T, Tideman P, Rosén I, Lundgren J, Tideman E. Epilepsy surgery in children with drug-resistant epilepsy, a long-term follow-up. Acta Neurol Scand 2013; 128:414-21. [PMID: 23742270 DOI: 10.1111/ane.12154] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this follow-up study, we wanted to present the long-term outcome (5-21 years) in terms of seizure freedom, seizure reduction, and the cognitive development in the first 47 children who underwent epilepsy surgery at the University Hospital in Lund from 1991 to 2007. MATERIALS AND METHODS All children who underwent epilepsy surgery in the southern region of Sweden were assessed for cognitive function before surgery and at follow-up. A review of medical documents for demographic data and seizure-related characteristics was made by retrospectively examining the clinical records. RESULTS Forty-seven children with a median age at surgery of 8 years (range 0.5-18.7 years) were included. Twenty-three children achieved seizure freedom, six demonstrated >75% improvement in seizure frequency, and none of the children experienced an increase in seizure frequency. Twenty-one children required a reoperation to achieve satisfactory seizure outcomes. Cognitive functional level was preserved, and the majority of patients, 34 (76%), followed their expected cognitive trajectory. The patients who became seizure free significantly improved their cognitive processing speed, even after long-term follow-up. CONCLUSIONS Epilepsy surgery in children offers suitable candidates a good chance of significantly improved outcome and low rates of complications. Several children, however, required a reoperation to achieve satisfactory seizure outcomes. Cognitive level was preserved, and the majority of patients followed their expected cognitive trajectory. Cognitive improvements in processing speed appear to occur in parallel with seizure control and were even more pronounced in subjects with no anti-epilepsy drugs. These improvements persisted even after long-term follow-up.
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Affiliation(s)
- T. Hallböök
- Department of Pediatrics; Sahlgrenska Academy; Institution of Clinical Sciences; University of Gothenburg; Gothenburg Sweden
| | - P. Tideman
- Department of Psychology; Lund University; Lund Sweden
| | - I. Rosén
- Department of Clinical Neurophysiology; Skane University Hospital; Lund Sweden
| | - J. Lundgren
- Department of Pediatrics; Skane University Hospital; Lund Sweden
| | - E. Tideman
- Department of Psychology; Lund University; Lund Sweden
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'With the benefit of hindsight': would you opt again for epilepsy surgery performed in childhood? Eur J Paediatr Neurol 2013; 17:462-70. [PMID: 23570833 DOI: 10.1016/j.ejpn.2013.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/11/2012] [Accepted: 02/27/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND How adolescents and their caregivers look back on epilepsy surgery performed in early life, and whether epilepsy-related restrictions are still in force years after the operation, are insufficiently known. AIMS To obtain retrospective evaluations of the decision for epilepsy surgery at an early age, and to inventory current epilepsy-related restrictions. METHODS Of 177 children who underwent epilepsy surgery between 1992 and 2009, 129 could be approached. They and their parents received a rating list inventorying whether, in retrospect, they would opt again for epilepsy surgery, which were motives for their answer, how successful they felt surgery had been and which, if any, epilepsy-related restrictions were still in force. RESULTS Forty-one of 44 seizure-free adolescents and 9 of 10 adolescents with current seizures were inclined to (re-)opt for surgery. Parents also would in majority re-opt for surgery. Age at surgery, post-surgical interval, nor type of surgery was statistically significantly related with re-opting for surgery. Seizure-freedom was the paramount motive of seizure-free respondents; respondents with current seizures in majority mentioned amelioration of seizures and/or medication. For parents of children with current seizures, a better developmental perspective was another important motive. Rare hesitation/refusal was related to uncertainties in weighing advantages and disadvantages. Current seizures were no reason to consider surgery as a failure. Among children who were free of both seizures and anti-epileptic drugs, 42% lived with restrictions. CONCLUSIONS Epilepsy surgery that does not result in seizure freedom is nevertheless felt to be beneficial. Proper advice should prevent meaningless continuation of restrictions.
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Edelvik A, Rydenhag B, Olsson I, Flink R, Kumlien E, Källén K, Malmgren K. Long-term outcomes of epilepsy surgery in Sweden: a national prospective and longitudinal study. Neurology 2013; 81:1244-51. [PMID: 23966252 PMCID: PMC3795607 DOI: 10.1212/wnl.0b013e3182a6ca7b] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden. Methods: Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls. Results: In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p < 0.001) and 38% of nonoperated children (not significant). Forty-one percent of operated adults and 44% of operated children had sustained seizure freedom since surgery, compared to none of the controls (p < 0.0005). Multivariate analysis identified ≥30 seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p < 0.0005). Conclusions: This population-based, prospective study shows good long-term seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults. Classification of evidence: This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.
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Affiliation(s)
- Anna Edelvik
- From the Epilepsy Research Group, Institute of Neuroscience and Physiology (A.E., B.R., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University; Departments of Clinical Neurophysiology (R.F.) and Neurology (E.K.), Uppsala University Hospital; and Department of Neurology (K.K.), Institution of Clinical Neurosciences, Lund University, Sweden
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Lee YJ, Lee JS. Temporal lobe epilepsy surgery in children versus adults: from etiologies to outcomes. KOREAN JOURNAL OF PEDIATRICS 2013; 56:275-81. [PMID: 23908666 PMCID: PMC3728445 DOI: 10.3345/kjp.2013.56.7.275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 02/01/2013] [Indexed: 11/27/2022]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of medically intractable epilepsy in adults and children, and mesial temporal sclerosis is the most common underlying cause of TLE. Unlike in the case of adults, TLE in infants and young children often has etiologies other than mesial temporal sclerosis, such as tumors, cortical dysplasia, trauma, and vascular malformations. Differences in seizure semiology have also been reported. Motor manifestations are prominent in infants and young children, but they become less obvious with increasing age. Further, automatisms tend to become increasingly complex with age. However, in childhood and especially in adolescence, the clinical manifestations are similar to those of the adult population. Selective amygdalohippocampectomy can lead to excellent postoperative seizure outcome in adults, but favorable results have been seen in children as well. Anterior temporal lobectomy may prove to be a more successful surgery than amygdalohippocampectomy in children with intractable TLE. The presence of a focal brain lesion on magnetic resonance imaging is one of the most reliable independent predictors of a good postoperative seizure outcome. Seizure-free status is the most important predictor of improved psychosocial outcome with advanced quality of life and a lower proportion of disability among adults and children. Since the brain is more plastic during infancy and early childhood, recovery is promoted. In contrast, long epilepsy duration is an important risk factor for surgically refractory seizures. Therefore, patients with medically intractable TLE should undergo surgery as early as possible.
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Affiliation(s)
- Yun-Jin Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Hauptman JS, Pedram K, Sison CA, Sankar R, Salamon N, Vinters HV, Mathern GW. Pediatric epilepsy surgery: long-term 5-year seizure remission and medication use. Neurosurgery 2013; 71:985-93. [PMID: 22895408 DOI: 10.1227/neu.0b013e31826cdd5a] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unclear whether long-term seizure outcomes in children are similar to those in adult epilepsy surgery patients. OBJECTIVE To determine 5-year outcomes and antiepilepsy drug (AED) use in pediatric epilepsy surgery patients from a single institution. METHODS The cohort consisted of children younger than 18 years of age whose 5-year outcome data would have been available by 2010. Comparisons were made between patients with and without 5-year data (n = 338), patients with 5-year data for seizure outcome (n = 257), and seizure-free patients on and off AEDs (n = 137). RESULTS Five-year data were available from 76% of patients. More seizure-free patients with focal resections for hippocampal sclerosis and tumors lacked 5-year data compared with other cases. Of those with 5-year data, 53% were continuously seizure free, 18% had late seizure recurrence, 3% became seizure free after initial failure, and 25% were never seizure free. Patients were more likely to be continuously seizure free if their surgery was performed during the period 2001 to 2005 (68%) compared with surgery performed from 1996 to 2000 (61%), 1991 to 1995 (36%), and 1986 to 1990 (46%). More patients had 1 or fewer seizures per month in the late seizure recurrence (47%) compared with the not seizure-free group (20%). Four late deaths occurred in the not seizure-free group compared with 1 in the seizure-free group. Of patients who were continuously seizure free, 55% were not taking AEDs, and more cortical dysplasia patients (74%) had stopped taking AEDs compared with hemimegalencephaly patients (18%). CONCLUSION In children, 5-year outcomes improved over 20 years of clinical experience. Our results are similar to those of adult epilepsy surgery patients despite mostly extratemporal and hemispheric operations for diverse developmental etiologies.
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Affiliation(s)
- Jason S Hauptman
- Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Giulioni M, Marucci G, Martinoni M, Volpi L, Riguzzi P, Marliani AF, Bisulli F, Tinuper P, Tassinari CA, Michelucci R, Rubboli G. Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications. J Neurosurg 2013; 119:37-47. [PMID: 23641822 DOI: 10.3171/2013.3.jns122132] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT The study was performed to investigate the relation between seizure outcome after surgical treatment of mesial temporal lobe epilepsy (MTLE) and pathological findings, classified according to the recently proposed classifications of mesial temporal sclerosis (MTS), granule cell pathology (GCP), focal cortical dysplasia (FCD) and epilepsy-associated low-grade tumors (ELGT). METHODS The authors analyzed data obtained in 120 consecutive cases involving patients presenting with drug-resistant MTLE, who underwent tailored anteromesial temporal lobe resection, and correlated seizure outcome with pathological findings. They identified 5 histopathological groups: Group 1-ELGT, alone or associated with other lesions (30 cases); Group 2-isolated FCD (17 cases); Group 3-MTS, with or without GCP (28 cases); Group 4-MTS associated with FCD, with or without GCP (37 cases); Group 5-other lesions (8 cases). RESULTS Engel Class I outcome was observed in 83% of patients with ELGT (Class IA in 63%); in 59% of patients with isolated FCD, with FCD Type II showing a better prognosis than FCD Type I; in 82% of patients with isolated MTS (Class IA in 50%), with MTS Type 1a and MTS Type 1b showing a better prognosis than MTS Type 2 and patients with MTS and GCP having better postsurgical results than those with MTS without GCP. Engel Class I outcome was also achieved in 84% of patients with FCD associated with MTS (Engel Class IA in 62%); also in this group MTS 1a and MTS 1b associated with FCD showed a better prognosis than FCD associated with MTS 2. Finally, Engel Class I was also achieved in 2 patients with vascular malformation and in 1 with a temporal pole encephalocele. CONCLUSIONS Patients with MTLE and ELGT, MTS, or MTS associated with FCD showed the best postsurgical seizure outcome (Engel Class I in more than 80% of cases), whereas only 63% of patients with isolated FCD achieved the same type of outcome. Interestingly, the analysis of seizure outcome in histopathological subtypes of FCD and of MTS showed different prognoses in the different pathological subgroups, with worse outcomes for atypical MTS, absence of GCP, and isolated FCD Type I.
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Affiliation(s)
- Marco Giulioni
- Division of Neurosurgery, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy.
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Long-term outcomes of epilepsy surgery in school-aged children with partial epilepsy. Pediatr Neurol 2012; 47:284-90. [PMID: 22964443 DOI: 10.1016/j.pediatrneurol.2012.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/20/2012] [Indexed: 11/24/2022]
Abstract
The pediatric epileptic spectrum and seizure control in surgical patients have been defined in developed countries. However, corresponding data on school-aged children from developing countries are insufficient. We summarized epileptic surgical data from four centers in China, to compare surgical outcomes of school-aged children with intractable partial epilepsy from China and those from developed countries, and introduce surgical candidate criteria. Data from 206 children (aged 6-14 years) undergoing surgical resection for epilepsy between September 2001 and January 2007 were selected. Postoperative freedom from seizures was achieved in 173 cases (84.0%) at 1 year, 149 (72.3%) at 3 years, and 139 (67.5%) at 5 years. Patients with focal magnetic resonance imaging abnormalities and a short history of seizure were most likely to become seizure-free postoperatively. Those with preoperative low intelligence quotients who became seizure-free postoperatively achieved improvements in full memory quotients, intelligence quotients, and overall quality of life at 2 years. Significant differences were evident in mean changes of full intelligence quotient, full memory quotient, and overall quality of life between patients with preoperative low intelligence quotients who received corpus callosotomies and those with a normal preoperative intelligence quotient, and between seizure-free children and those with continual seizures.
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