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Seizure Disorders

Seizure Outcomes of Epilepsy Surgery in Children

Authors:

Sandi Lam ,

Division of Pediatric Neurosurgery, Ann & Robert H Lurie Children's Hospital, Chicago, IL; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
About Sandi
Dr. Sandi Lam is a pediatric neurosurgeon with clinical subspecialization in the areas of pediatric cerebrovascular surgery, epilepsy surgery and craniofacial surgery with a focus on minimally invasive and endoscopic techniques. She is the chief of Pediatric Neurosurgery at Lurie Children's Hospital in Chicago and professor in the Department of Neurosurgery at Northwestern University Feinberg School of Medicine. Her research focuses on quality, outcomes, and healthcare utilization for children and neurological surgery; this examines clinical outcomes and also socioeconomic factors and policies that influence and impact access and delivery of subspecialty care, particularly in epilepsy. She is also involved in global neurosurgery, with over 10 years of experience in skill- and knowledge transfer for pediatric neurosurgery in the developing world. She works with multiple scientific publications, and is a member of the editorial board of the Journal of Neurosurgery, Pediatrics.
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Hyman G Frankel

Division of Pediatric Neurosurgery, Ann & Robert H Lurie Children's Hospital, Chicago, IL; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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Abstract

Investigators from the Hospital for Sick Children in Toronto reviewed the literature pertaining to seizure outcomes following epilepsy surgery in the pediatric population.
How to Cite: Lam, S. and Frankel, H.G., 2021. Seizure Outcomes of Epilepsy Surgery in Children. Pediatric Neurology Briefs, 35, p.2. DOI: http://doi.org/10.15844/pedneurbriefs-35-2
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  Published on 06 Jan 2021
 Accepted on 22 Nov 2020            Submitted on 07 Apr 2020

Investigators from the Hospital for Sick Children in Toronto reviewed the literature pertaining to seizure outcomes following epilepsy surgery in the pediatric population [1]. The aim of this systematic review and meta-analysis of 258 studies was to estimate the effect of surgery on long-term seizure outcomes as compared to medical management; the authors further sub-divided outcomes based on location, pathology, lesional vs non-lesional and incomplete vs complete resection. Eleven studies compared surgery with a medical control group; the odds of seizure freedom were significantly higher in the surgical group compared with medical therapy. Evaluation of 68 studies which included mixed pathologies and surgical locations demonstrated an overall seizure freedom rate of 64.8% at one year, decreasing over the first five years, and precipitously dropping off at ten years. Hemispheric surgery demonstrated the highest seizure freedom rate (74.7%), followed by temporal lobe epilepsy surgery (73.3%) and extratemporal lobe epilepsy surgery (60.2%). Non-lesional epilepsy carried a seizure freedom rate of 51.5% following surgery. Ten studies compared non-lesional and lesional epilepsy which demonstrated a lower odds of seizure freedom in non-lesional epilepsy. Fifteen studies reported outcomes of incomplete versus complete resection with lower odds of seizure freedom following incomplete seizure resection for incomplete resection. The authors conclude that surgery should be the recommended treatment for pediatric patients with drug resistant epilepsy who are eligible for surgery and in particular those who have lesional epilepsy.

COMMENTARY. The global burden of epilepsy in the pediatric population remains substantial, with a prevalence of up to 1%, and 20-30% of those patients further diagnosed with drug resistant epilepsy [2]. Epilepsy brings with it a significant increased risk of developmental and cognitive delay and decreased quality of life for both the patient and their caregivers. Early surgical intervention has shown benefit for cognitive outcomes and quality of life for both the patient and family [3 - 5]. Despite this evidence, there is often a delay from time of diagnosis to surgical evaluation, and surgery remains an underutilized resource [6 - 7]. This systematic review highlights significant evidence to the growing cohort of literature supporting the benefits of pediatric epilepsy surgery. This is especially true for patients with lesional epilepsy and should serve as further impetus to refer pediatric patients for surgical evaluation earlier.

Disclosures

The authors have declared that no competing interests exist.

References

  1. Widjaja, E, Jain, P, Demoe, L, Guttmann, A, Tomlinson, G and Sander, B (2020). Seizure outcome of pediatric epilepsy surgery: systematic review and meta-analyses. Neurology Feb 202094(7): 311–21. https://doi.org/10.1212/WNL.0000000000008966. [PubMed]  

  2. Berg, AT, Jallon, P and Preux, PM (2013). The epidemiology of seizure disorders in infancy and childhood: definitions and classifications. Handb Clin Neurol 111: 391–8. https://doi.org/10.1016/B978-0-444-52891-9.00043-9. [PubMed]  

  3. Van Schooneveld, MM and Braun, KP (2013). Cognitive outcome after epilepsy surgery in children. Brain Dev Sep 201335(8): 721–9. https://doi.org/10.1016/j.braindev.2013.01.011. [PubMed]  

  4. Loddenkemper, T, Holland, KD, Stanford, LD, Kotagal, P, Bingaman, W and Wyllie, E (2007). Developmental outcome after epilepsy surgery in infancy. Pediatrics May 2007119(5): 930–5. https://doi.org/10.1542/peds.2006-2530. [PubMed]  

  5. Braun, KP and Cross, JH (2018). Pediatric epilepsy surgery: the earlier the better. Expert Rev Neurother Apr 201818(4): 261–3. https://doi.org/10.1080/14737175.2018.1455503. [PubMed]  

  6. Pestana Knight, EM, Schiltz, NK, Bakaki, PM, Koroukian, SM, Lhatoo, SD and Kaiboriboon, K (2015). Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009. Epilepsia 56(3): 375–81. https://doi.org/10.1111/epi.12912. 

  7. Lim, ME Bowen, JM Snead, OC 3rd Elliott, I Donner, E Weiss, SK et al. (2013). Access to surgery for paediatric patients with medically refractory epilepsy: a systems analysis. Epilepsy Res Dec 2013107(3): 286–96. https://doi.org/10.1016/j.eplepsyres.2013.08.010. [PubMed]  


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