Subject(s)
Epilepsy/surgery , Malformations of Cortical Development/complications , Neurocutaneous Syndromes/complications , Neurocutaneous Syndromes/surgery , Child , Child, Preschool , Electroencephalography , Epilepsy/complications , Female , Humans , Infant , Infant, Newborn , Male , Malformations of Cortical Development/surgery , Seizures , Video RecordingABSTRACT
OBJECTIVE: To understand the role of epilepsy surgery in children with generalized or bilateral findings on preoperative scalp EEG. METHODS: From our pediatric epilepsy surgery series, we identified 50 patients in whom 30 to 100% of preoperative epileptiform discharges (ictal, interictal, or both) were generalized or contralateral to the side of surgery. RESULTS: All patients had severe refractory epilepsy and an epileptogenic lesion on brain MRI. Ninety percent of the lesions were congenital, perinatal, or acquired during infancy, predominantly malformations of cortical development (44%) or cystic encephalomalacia (40%). Age at surgery was 0.2 to 24 (median 7.7) years. Surgeries were hemispherectomy (64%) or lobar or multilobar resection. At last follow-up (median 24.0 months), 72% of patients were seizure-free, 16% had marked improvement with only brief episodes of staring or tonic stiffening, and 12% were not improved. The rate of seizure-free outcome was not significantly associated with age at seizure onset or surgery, presence of hemiparesis or focal clinical features during seizures, type of lesion, or surgery type. Postoperative seizure-free rate did not differ from that in a comparison group of similar patients who matched the study group except for their high percentage (70 to 100%) of ipsilateral ictal and interictal epileptiform discharges on preoperative EEG. CONCLUSIONS: Epilepsy surgery may be successful for selected children and adolescents with a congenital or early-acquired brain lesion, despite abundant generalized or bilateral epileptiform discharges on EEG. The diffuse EEG expression may be due to an interaction between the early lesion and the developing brain.
Subject(s)
Brain/abnormalities , Brain/surgery , Epilepsy/etiology , Epilepsy/surgery , Nervous System Malformations/complications , Neurosurgical Procedures/statistics & numerical data , Adolescent , Adult , Age Factors , Brain/physiopathology , Child , Child, Preschool , Decision Support Techniques , Electroencephalography/methods , Epilepsy/diagnosis , Female , Functional Laterality/physiology , Humans , Infant , Magnetic Resonance Imaging , Male , Nervous System Malformations/physiopathology , Neural Pathways/physiopathology , Neurosurgical Procedures/methods , Neurosurgical Procedures/standards , Patient Selection , Predictive Value of Tests , Preoperative Care , Risk Assessment , Treatment OutcomeABSTRACT
The authors reviewed preoperative MRI and EEG findings in relation to postsurgical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis complex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities offered seizure freedom (8/9, 89%; median follow-up 25 months) comparable to other focal etiologies. Patients with nonconcordant MRI and EEG findings did less well (3/8, 38%, seizure free; p = 0.027, OR = 13).
Subject(s)
Brain/surgery , Epilepsy/diagnosis , Epilepsy/surgery , Patient Selection , Tuberous Sclerosis/complications , Tuberous Sclerosis/surgery , Adolescent , Adult , Brain/pathology , Brain/physiopathology , Causality , Child , Child, Preschool , Electroencephalography/standards , Epilepsy/etiology , Female , Humans , Infant , Magnetic Resonance Imaging/standards , Male , Neurosurgical Procedures/standards , Prognosis , Retrospective Studies , Treatment Outcome , Tuberous Sclerosis/pathologyABSTRACT
Prolonged high-dose suppressive therapy (HDST) is a mainstay in the management of refractory status epilepticus (RSE), albeit with high morbidity and mortality. The authors studied 10 patients who were carefully selected for epilepsy surgery after failing prolonged (>2 weeks) HDST. Status epilepticus was stopped acutely in all of them with no mortality and no substantial morbidity. At follow-up (median 7 months), 7 (70%) of 10 patients were seizure free, and 3 (30%) of 10 had significant improvement in their epilepsy.