Therapeutic analysis of reoperation in drug resistant epilepsy in 4 children after failed surgery / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the outcome of reoperation in drug resistant epilepsy after failed surgery or recurrence in children,and to identify the predictors of the outcome of reoperation and inspiration of epilepsy resection surgery.Methods Analysis was done on data of 4 patients with drug resistant epilepsy diagnosed in Department of Neurosurgery Epileptic Center,Fuzhou General Hospital of Nanjing Military Command from Sep.2011 to Sep.2012.Clinical manifestation,preoperative evaluation,postoperative follow-up of the children were analyzed.Results After first epilepsy resection surgery,3 patients had little decrease in seizure rate(Engel class Ⅳ),the other one had seizure freedom (Engel class Ⅰ),but got recurrence after 2 years.Four cases were all underwent extended resection reoperation du-ring the study period.Types resection included temporoparietooccipital (3/4 cases) and frontal (1/4 cases),mean follow-up 11.25 months.One of the 4 patients had seizure freedom (Engel class Ⅰ),and 3 cases of the 4 patients had seizure reduction (Engel class Ⅱ) at last follow-up,in addition,none of them had significant or unacceptable complication.Conclusions Patients with recurrent drug resistant epilepsy after an initial resection surgery can regain seizure freedom outcome when they underwent repeat resection surgery after comprehensive reevaluation.Predictors with likelihood of seizure freedom after reoperation are(1) retained medial temporal structures or relevant magnetic resonance imaging structural lesion;(2) original surgery suboptimal; (3) preceding evaluation suggests solitary identified focus;(4) semiology relate to preoperative seizures.