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Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center.
Epilepsy Behav 2016; 63:67-72EB

Abstract

OBJECTIVE

This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom.

METHODS

This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom.

RESULTS

Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia.

SIGNIFICANCE

Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom.

Authors+Show Affiliations

Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey.Ankara University School of Medicine, Department of Neurosurgery, Ankara, Turkey.Department of Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.Department of Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey.Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey.Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.Department of Pediatric Neurology & Epilepsy Center, Gazi University School of Medicine, Ankara, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27566969

Citation

Hirfanoglu, Tugba, et al. "Outcomes of Resective Surgery in Children and Adolescents With Focal Lesional Epilepsy: the Experience of a Tertiary Epilepsy Center." Epilepsy & Behavior : E&B, vol. 63, 2016, pp. 67-72.
Hirfanoglu T, Serdaroglu A, Kurt G, et al. Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center. Epilepsy Behav. 2016;63:67-72.
Hirfanoglu, T., Serdaroglu, A., Kurt, G., Erdem, A., Capraz, I., Bilir, E., ... Aydin, K. (2016). Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center. Epilepsy & Behavior : E&B, 63, pp. 67-72. doi:10.1016/j.yebeh.2016.07.039.
Hirfanoglu T, et al. Outcomes of Resective Surgery in Children and Adolescents With Focal Lesional Epilepsy: the Experience of a Tertiary Epilepsy Center. Epilepsy Behav. 2016;63:67-72. PubMed PMID: 27566969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center. AU - Hirfanoglu,Tugba, AU - Serdaroglu,Ayse, AU - Kurt,Gokhan, AU - Erdem,Atilla, AU - Capraz,Irem, AU - Bilir,Erhan, AU - Vural,Ozge, AU - Ucar,Murat, AU - Oner,Ali Yusuf, AU - Onal,Baran, AU - Akdemir,Ozgur, AU - Atay,Ozlem, AU - Arhan,Ebru, AU - Aydin,Kursad, Y1 - 2016/08/25/ PY - 2016/05/03/received PY - 2016/07/14/revised PY - 2016/07/28/accepted PY - 2016/8/28/pubmed PY - 2017/9/2/medline PY - 2016/8/28/entrez KW - Children KW - Epilepsy surgery KW - Focal lesion KW - Predictive factors SP - 67 EP - 72 JF - Epilepsy & behavior : E&B JO - Epilepsy Behav VL - 63 N2 - OBJECTIVE: This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom. METHODS: This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom. RESULTS: Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia. SIGNIFICANCE: Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom. SN - 1525-5069 UR - https://www.unboundmedicine.com/medline/citation/27566969/Outcomes_of_resective_surgery_in_children_and_adolescents_with_focal_lesional_epilepsy:_The_experience_of_a_tertiary_epilepsy_center_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-5050(16)30315-8 DB - PRIME DP - Unbound Medicine ER -