Epilepsy surgery in children and adolescence; Phramongkutklao College of Medicine's experience.

ABSTRACT

OBJECTIVES: To evaluate the safety and efficacy of epilepsy surgery in children and adolescence at Comprehensive Epilepsy Center, Phramongkutklao College of Medicine. MATERIAL AND METHOD: Children and adolescents, who underwent epilepsy surgery at Comprehensive Epilepsy Center, Phramongkutklao College of Medicine were identified from the epilepsy surgery database. The following parameters were evaluated age at surgery, duration of seizure prior to surgery, presurgical work up, presurgical as well as postsurgical neurological/ seizure status and neuropathology (if applicable). All follow-up data were obtained through clinic visits. RESULTS: Fifteen children who underwent epilepsy surgery between January 1, 2003 and March 31, 2005 were identified. Age at surgery ranged from 2.5 years to 19 years (mean age=8.2 years). Seizure duration prior to surgery ranged from 1 year to 17 years (mean=4.7 years). Eight patients (53%) had partial seizures and underwent excisional procedures [5 temporal lobectomy, 2 left frontal corticectomy, and 1 left functional hemispherectomy]. Seven patients (47%) had generalized seizures and underwent anterior 2/3 corpus callosotomy. Pathological information was available for all 8 cases with partial epilepsy. Four out of eight cases with pathological information demonstrated cortical dysplasia, four revealed hippocampal sclerosis, and two patients had dysembryoplastic neuroepithelial tumor (DNET). At follow-up, all 5 patients with temporal lobectomy and a child who underwent functional hemispherectomy were seizure free (follow up period 3-31 months). Two children with extratemporal resective surgery [left frontal corticectomy] showed remarkable improvement with rare breakthrough seizures (follow up period= 3 and 19 months respectively). Four out of seven patients with corpus collosotomy had worthwhile improvement of seizures (follow up period=4-19 months), while another two children were seizure free during short-termed follow up postoperatively (follow up period=1 and 2 months). All patients did not have significant neurological deterioration or worsening of seizure after the surgery. CONCLUSION: Resective epilepsy surgery in Thai pediatric populations in the authors' experience seems to be safe and effective in selected patients. Most children who underwent callosotomy had a significant reduction in intensity and frequency of tonic, atonic, and tonic-clonic seizures. Dual pathology was common in refractory temporal lobe epilepsy with hippocampal sclerosis. Although the study sample was small, it did advocate several larger studies with the same findings.