Yun-Jin Lee1, Joon Soo Lee2, Hoon-Chul Kang2, Dong-Seok Kim3, Kyu-Won Shim3, Soyong Eom4, Heung Dong Kim5. 1. Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Republic of Korea. 2. Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Republic of Korea. 3. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Republic of Korea. 4. Department of Psychiatrics, Severance Hospital, Yonsei University College of Medicine, Republic of Korea. 5. Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Republic of Korea. Electronic address: hdkimmd@yuhs.ac.
Abstract
PURPOSE: to evaluate the outcomes and role of epilepsy surgery in children with intractable epileptic encephalopathy (EE). METHODS: ninety-five children (64 boys, 31 girls) with intractable EE were treated by epilepsy surgery at Severance Children's Hospital from 2003 to 2008. Surgical treatments included lobar resection, hemispherotomy and corpus callosotomy (CC). Seventy-six children were Lennox-Gastaut syndrome (LGS), and 19 had West syndrome. RESULTS: of the 76 patients with LGS, CC was performed in 37 patients (48.7%), lobar resection in 29 (38.2%) and hemispherotomy in 10 (13.2%). Of the 19 patients with West syndrome, respective surgery was performed in 15 patients (78.9%) and CC in 4 (21.1%). Of the patients receiving respective surgery, Engel's class I outcomes were achieved for 24 of 39 (61.5%) of LGS patients, and for 9 of 15 (60.0%) of West syndrome. Malformations of cortical development were commonly observed, appearing in 73.5% (36/49). In neuropsychiatric tests, 19 of 27 with LGS demonstrated improvement in postoperative cognitive function. More significant intellectual improvement correlated well with shorter epilepsy duration, good seizure outcomes, and decreased number of antiepileptic drugs. CONCLUSIONS: epilepsy surgery should be considered in treating childhood intractable EE with expectation of improvement of both seizure and cognitive outcomes, even in cases of LGS.
PURPOSE: to evaluate the outcomes and role of epilepsy surgery in children with intractable epilepticencephalopathy (EE). METHODS: ninety-five children (64 boys, 31 girls) with intractable EE were treated by epilepsy surgery at Severance Children's Hospital from 2003 to 2008. Surgical treatments included lobar resection, hemispherotomy and corpus callosotomy (CC). Seventy-six children were Lennox-Gastaut syndrome (LGS), and 19 had West syndrome. RESULTS: of the 76 patients with LGS, CC was performed in 37 patients (48.7%), lobar resection in 29 (38.2%) and hemispherotomy in 10 (13.2%). Of the 19 patients with West syndrome, respective surgery was performed in 15 patients (78.9%) and CC in 4 (21.1%). Of the patients receiving respective surgery, Engel's class I outcomes were achieved for 24 of 39 (61.5%) of LGSpatients, and for 9 of 15 (60.0%) of West syndrome. Malformations of cortical development were commonly observed, appearing in 73.5% (36/49). In neuropsychiatric tests, 19 of 27 with LGS demonstrated improvement in postoperative cognitive function. More significant intellectual improvement correlated well with shorter epilepsy duration, good seizure outcomes, and decreased number of antiepileptic drugs. CONCLUSIONS:epilepsy surgery should be considered in treating childhood intractable EE with expectation of improvement of both seizure and cognitive outcomes, even in cases of LGS.
Authors: Barbora Benova; Anezka Belohlavkova; Petr Jezdik; Alena Jahodová; Martin Kudr; Vladimir Komarek; Vilem Novak; Petr Liby; Robert Lesko; Michal Tichý; Martin Kyncl; Josef Zamecnik; Pavel Krsek; Alice Maulisova Journal: PeerJ Date: 2019-10-08 Impact factor: 2.984