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Seizure outcomes after temporal lobectomy in pediatric patients.
J Neurosurg Pediatr 2013; 12(2):134-41JN

Abstract

Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults and is responsible for 15%-20% of epilepsy cases in children. Class I evidence strongly supports the use of temporal lobectomy for intractable TLE in adults, but fewer studies have examined seizure outcomes and predictors of seizure freedom after temporal lobectomy in pediatric patients. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after temporal lobectomy for TLE. Thirty-six studies met their inclusion criteria. These 36 studies included 1318 pediatric patients with a mean age (± SEM) of 10.7 ± 0.3 years. Overall, seizure freedom (Engel Class I outcome) was achieved in 1002 cases (76%); 316 patients (24%) continued to have seizures (Engel Class II-IV outcome). All patients had at least 1 year of follow-up. Statistically significant predictors of seizure freedom after surgery included lesional epilepsy etiology (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02-1.15), abnormal findings on preoperative MRI (OR 1.27, 95% CI 1.16-1.40), and lack of generalized seizures (OR 1.36, 95% CI 1.20-1.56). Among lesional epilepsy cases, there was a trend toward better outcome with gross-total lesionectomy than with subtotal resection. Approximately three-fourths of pediatric patients with TLE attain seizure freedom after temporal lobectomy. Favorable outcomes may be predicted by lesional epilepsy etiology, abnormal MRI, and lack of generalized seizures. Pediatric patients with medically refractory TLE should be referred to a comprehensive pediatric epilepsy center for surgical evaluation.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA. EnglotDJ@neurosurg.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

23768202

Citation

Englot, Dario J., et al. "Seizure Outcomes After Temporal Lobectomy in Pediatric Patients." Journal of Neurosurgery. Pediatrics, vol. 12, no. 2, 2013, pp. 134-41.
Englot DJ, Rolston JD, Wang DD, et al. Seizure outcomes after temporal lobectomy in pediatric patients. J Neurosurg Pediatr. 2013;12(2):134-41.
Englot, D. J., Rolston, J. D., Wang, D. D., Sun, P. P., Chang, E. F., & Auguste, K. I. (2013). Seizure outcomes after temporal lobectomy in pediatric patients. Journal of Neurosurgery. Pediatrics, 12(2), pp. 134-41. doi:10.3171/2013.5.PEDS12526.
Englot DJ, et al. Seizure Outcomes After Temporal Lobectomy in Pediatric Patients. J Neurosurg Pediatr. 2013;12(2):134-41. PubMed PMID: 23768202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Seizure outcomes after temporal lobectomy in pediatric patients. AU - Englot,Dario J, AU - Rolston,John D, AU - Wang,Doris D, AU - Sun,Peter P, AU - Chang,Edward F, AU - Auguste,Kurtis I, Y1 - 2013/06/14/ PY - 2013/6/18/entrez PY - 2013/6/19/pubmed PY - 2013/11/2/medline SP - 134 EP - 41 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 12 IS - 2 N2 - Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults and is responsible for 15%-20% of epilepsy cases in children. Class I evidence strongly supports the use of temporal lobectomy for intractable TLE in adults, but fewer studies have examined seizure outcomes and predictors of seizure freedom after temporal lobectomy in pediatric patients. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after temporal lobectomy for TLE. Thirty-six studies met their inclusion criteria. These 36 studies included 1318 pediatric patients with a mean age (± SEM) of 10.7 ± 0.3 years. Overall, seizure freedom (Engel Class I outcome) was achieved in 1002 cases (76%); 316 patients (24%) continued to have seizures (Engel Class II-IV outcome). All patients had at least 1 year of follow-up. Statistically significant predictors of seizure freedom after surgery included lesional epilepsy etiology (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02-1.15), abnormal findings on preoperative MRI (OR 1.27, 95% CI 1.16-1.40), and lack of generalized seizures (OR 1.36, 95% CI 1.20-1.56). Among lesional epilepsy cases, there was a trend toward better outcome with gross-total lesionectomy than with subtotal resection. Approximately three-fourths of pediatric patients with TLE attain seizure freedom after temporal lobectomy. Favorable outcomes may be predicted by lesional epilepsy etiology, abnormal MRI, and lack of generalized seizures. Pediatric patients with medically refractory TLE should be referred to a comprehensive pediatric epilepsy center for surgical evaluation. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/23768202/Seizure_outcomes_after_temporal_lobectomy_in_pediatric_patients_ L2 - https://thejns.org/doi/10.3171/2013.5.PEDS12526 DB - PRIME DP - Unbound Medicine ER -