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Surgical Treatment of Epilepsy in Pediatric Patients

Published online by Cambridge University Press:  04 August 2016

Elaine Wyllie
Elaine Wyllie*
Affiliation:
Section of Pediatric Epilepsy, Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
*
Section of Pediatric Epilepsy, Department of Neurology/S51, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
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Abstract:

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Surgery has become an accepted treatment modality for carefully selected adults with intractable focal epilepsy. More recently, increasing numbers of pediatric patients with intractable epilepsy are also being referred for surgical consideration. Key elements of surgical candidacy include medically intractable focal epilepsy, a localized epileptogenic zone, and a low risk for new postoperative neurologic deficits. The most common etiologies of the epilepsies in pediatric surgical candidates are malformation of cortical development and low grade tumor but some patients with childhood onset temporal lobe epilepsy due to hippocampal sclerosis also present for early surgery. Based on results from several recent pediatric surgical series, the chance for favorable seizure outcome after surgery is not adversely affected by young age, with seizure-free postoperative outcome reported for 60% to 65% of infants, 59% to 67% of children, and 69% of adolescents, compared to 64% reported in a large, predominantly adult series. Some subgroups of patients have higher percentages of seizure-free outcome, including those with hippocampal sclerosis or low grade tumor. In addition to seizures, developmental issues are also a major concern in children with intractable epilepsy. Few quantitative data are available, but some anecdotal experience suggests that surgical relief of catastrophic epilepsy may result in resumption of developmental progression after surgery, although the rate of development often remains abnormal. In one series, best developmental outcomes were seen in patients with earliest surgery and highest level of preoperative development. For each patient, the timing of surgery must be carefully considered, based on a full assessment of the relative risks and benefits, derived from a detailed presurgical evaluation.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 2 , May 2000 , pp. 106 - 110
Copyright
Copyright © The Canadian Journal of Neurological 2000

References

REFERENCES

1. Engel, J Jr. Surgery for seizures. N Engl J Med 1996; 334(10):647–652.Google Scholar
2. Lüders, HO. Epilepsy Surgery. New York, NY: Raven Press, 1992.Google Scholar
3. Engel, J Jr. Surgical Treatment of the Epilepsies. New York, NY: Raven Press, 1993.Google Scholar
4. Wyllie, E, Comair, YG, Kotagal, P, et al. Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol 1998; 44:740–748.Google Scholar
5. Duchowny, M, Jayakar, P, Resnick, T, et al. Epilepsy surgery in the first three years of life. Epilepsia 1998; 39(7):737–743.Google Scholar
6. Chugani, HT, Shewmon, DA, Shields, WD, et al. Surgery for intractable infantile spasms: neuroimaging perspectives. Epilepsia 1993; 34:764–771.Google Scholar
7. Paolicchi, JM, Jayakar, P, Dean, P, et al. The outcome of focal resections in preadolescent children with intractable partial epilepsy. Neurology, in press.Google Scholar
8. Vining, EPG, Freeman, JM, Pillas, DJ, et al. Why would you remove half a brain? The outcome of 58 children after hemispherectomy – The Johns Hopkins Experience: 1968–1996. Pediatrics 1997; 100(2):163–171.Google Scholar
9. Chugani, HT, Shewmon, DA, Peacock, WJ, et al. Surgical treatment of intractable neonatal-onset seizures: the role of positron emission tomography. Neurology 1988; 38:1178–1188.CrossRefGoogle ScholarPubMed
10. Nashef, L, Fish, DR, Garner, S, Sander, JWAS, Shorvon, SD. Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia 1995; 36(12):1187–1193.Google Scholar
11. Sperling, MR, Feldman, H, Kinman, J, Liporace, JD, O’Connor, MJ. Seizure control and mortality in epilepsy. Ann Neurol 1999; 46(1):45–50.Google Scholar
12. Peacock, WJ, Comair, Y, Chugani, HT, Shewmon, DA, Shields, WD. Epilepsy surgery in childhood. In: Luders, HO, ed. Epilepsy Surgery. New York, NY: Raven Press, 1991: 589–598.Google Scholar
13. DeVos, K, Wyllie, E, Geckler, C, Kotagal, P, Comair, Y. Language dominance in patients with early childhood tumors near left hemisphere language areas. Neurology 1995; 45:349–356.Google Scholar
14. Mohamed, A, Wyllie, E, Ruggieri, P, et al. Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery: histopathology and seizure outcome. Submitted.Google Scholar
15. Zentner, J, Hufnagel, A, Ostertun, B, et al. Surgical treatment of extratemporal epilepsy: clinical, radiologic, and histopathologic findings in 60 patients. Epilepsia 1996; 37:1072–1080.Google Scholar
16. Sperling, MR, Saykin, AJ, Roberts, FD, French, JA, O’Connor, MJ. Occupational outcome after temporal lobectomy for refractory epilepsy. Neurology 1995; 45:970–977.Google Scholar
17. Huttenlocher, PR, Hapke, RJ. A follow-up study of intractable seizures in childhood. Ann Neurol 1990; 28:699–705.Google Scholar
18. Vasconcellos, E, Wyllie, E, Sullivan, S, et al. Mental retardation in pediatric candidates for epilepsy surgery: the role of early seizure onset. Submitted.Google Scholar
19. Purpura, DP. Dendritic differentiation in human cerebral cortex: normal and aberrant developmental patterns. In: Kreutzberg, GW, ed. Advances in Neurology. New York, NY: Raven Press, 1975: 91–134.Google Scholar
20. Dobbing, J, Sands, J. Quantitative growth and development of human brain. Arch Dis Child 1973; 48:757–767.Google Scholar
21. Peacock, WJ. Hemispherectomy for the treatment of intractable seizures in childhood. Neurosurg Clin N Am 1995; 6:549–563.Google Scholar
22. Collins, RC, Olney, JW, Lothman, EW. Metabolic and pathologic consequences of focal seizures. Res Publ Assoc Nerv Ment Dis 1983; 61:87–107.Google Scholar
23. Bourgeois, BFD, Prensky, AL, Palkes, HS, Talent, BK, Busach, SG. Intelligence in epilepsy: a prospective study in children. Ann Neurol 1983; 14:438–444.CrossRefGoogle ScholarPubMed
24. Asarnow, RF, LoPresti, C, Guthrie, D, et al. Developmental outcomes in children receiving resection surgery for medically intractable infantile spasms. Dev Med Child Neurol 1997; 39(7):430–440.CrossRefGoogle ScholarPubMed