Numbers
- Age at seizure onset was 1 year or less in 46% of patients.
- Intracranial electrodes were used in 27% of patients
Paediatric aetiology
Paediatric surgical management
Options
- Types of surgical treatment
- Harvey 2008
- Serious adverse events occurred in 19 patients (33%) in the surgery group, including hemiparesis in 15 (26%).
Surgical Procedure | Percentage of cases |
Lobar/focal lesionectomy | 48% |
Hemispherotomy | 16% |
Multilobar resection | 13% |
Vagus nerve stimulator | 16% |
Corpus callosotomy | 3% |
Other | 4% |
- Cortical resection of seizure focus
- With rare exceptions, the only chance for complete seizure control is with cortical resection.
- Factors that increase chance of seizure free
- Location of seizure focus (Temporal > extra-temporal)
- For extratemporal lobe or multiple lobe resections, most series report a 50-60% good or excellent outcome at 1-2 years.
- Unlike in adults, extratemporal lobe seizure foci are more common than temporal lobe foci in children (although children with isolated temporal lobe seizure foci can expect the same excellent outcomes as adults, and better than with other causes).
- Dual pathology (i.e. a primarily extratemporal focus and secondary temporal lobe involvement) is not uncommon in children but extratemporal foci are often difficult to identify or localize.
- For example, parietal foci are notorious for being clinically silent until the seizures spread or propagate to the frontal or temporal lobes and then present as a falsely localizing semiology.
- Children are also more prone to having multiple or multilobar seizure foci. Also, due to the limitations of surface EEG probes some children with MRI lesions causing focal seizure onset are initially thought to have nonsurgical generalized epilepsy.
- Presurgical duration of seizures (shorter the better)
- A well-defined lesion (vs No lesion)
- A tumour or vascular malformation
- Palliative surgery
- For children who are not reasonable candidates for resection of the seizure focus, palliative procedures offer significant potential to improve their quality of life.
- Reducing the seizure burden by making the seizures less debilitating in some facet greatly improves their quality of life.
Benefits of early surgery
- Offers effective treatment for children with intractable epilepsy
- Shorter the duration of uncontrolled seizures the better the outcome from surgery.
- Minimizes the disruption of a child’s cognitive and social development compared to peers,
- Decreasing the medical and traumatic risks of persistent seizures.
- SUDEP
Evidence
- Dwivedi 2017
- At 12 months, freedom from seizures occurred in 44 patients (77%) in the surgery group and in 4 (7%) in the medical-therapy group (P<0.001).
- Surgical patients also do functionally better