Navah Ester Kadish1,2, Thomas Bast3,4, Gitta Reuner5, Kathrin Wagner6, Hans Mayer3, Susanne Schubert-Bast5,7, Gert Wiegand1, Karl Strobl3, Armin Brandt6, Rudolf Korinthenberg8, Vera van Velthoven9, Andreas Schulze-Bonhage6, Josef Zentner9, Georgia Ramantani4,6,10. 1. Department of Neuropediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany. 2. Department of Medical Psychology and Medical Sociology, University Medical Centre Schleswig-Holstein, Kiel, Germany. 3. Epilepsy Centre Kork, Kehl-Kork, Germany. 4. Medical Faculty, University of Freiburg, Freiburg, Germany. 5. Section Neuropediatrics and Inborn Errors of Metabolism, University Children's Hospital, Heidelberg, Germany. 6. Epilepsy Centre, University Hospital Freiburg, Germany. 7. Department of Neuropediatrics, Goethe- University, Frankfurt am Main, Germany. 8. Division of Neuropediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital Freiburg, Germany. 9. Department of Neurosurgery, University Hospital Freiburg, Germany. 10. Department of Neuropediatrics, University Children's Hospital Zürich, Switzerland.
Abstract
BACKGROUND: Although the majority of children undergoing epilepsy surgery are younger than 3 yr at epilepsy manifestation, only few actually receive surgical treatment in early childhood. Past studies have, however, suggested that earlier intervention may correlate with superior developmental outcomes. OBJECTIVE: To identify predictors for long-term seizure freedom and cognitive development following epilepsy surgery in the first 3 yr of life and determine the appropriate timing for surgical treatment in this age group. METHODS: We retrospectively analyzed the data of 48 consecutive children aged 1.1 ± 0.7 yr at surgery. RESULTS: Final surgeries comprised 52% hemispherotomies, 13% multilobar, and 35% intralobar resections. Etiology included cortical malformations in 71%, peri- or postnatal ischemic lesions in 13%, and benign tumor or tuberous sclerosis in 8% each. At last follow-up (median 4.3, range 1-14.3 yr), 60% of children remained seizure-free: 38% had discontinued antiepileptic drugs. Intralobar lesionectomy resulted more often in seizure control than multilobar or hemispheric surgery. Postsurgical seizure freedom was determined by the completeness of resection. Early postsurgical seizures were key markers of seizure recurrence. Presurgical adaptive and cognitive developmental status was impaired in 89% children. Longer epilepsy duration and larger lesion extent were detrimental to presurgical development, which, in turn, determined the postsurgical developmental outcome. CONCLUSION: Our study demonstrates that epilepsy surgery in very young children is safe as well as efficient regarding long-term seizure freedom and antiepileptic drug cessation in selected candidates. Longer epilepsy duration is the only modifiable predictor of impaired adaptive and cognitive development, thus supporting early surgical intervention.
BACKGROUND: Although the majority of children undergoing epilepsy surgery are younger than 3 yr at epilepsy manifestation, only few actually receive surgical treatment in early childhood. Past studies have, however, suggested that earlier intervention may correlate with superior developmental outcomes. OBJECTIVE: To identify predictors for long-term seizure freedom and cognitive development following epilepsy surgery in the first 3 yr of life and determine the appropriate timing for surgical treatment in this age group. METHODS: We retrospectively analyzed the data of 48 consecutive children aged 1.1 ± 0.7 yr at surgery. RESULTS: Final surgeries comprised 52% hemispherotomies, 13% multilobar, and 35% intralobar resections. Etiology included cortical malformations in 71%, peri- or postnatal ischemic lesions in 13%, and benign tumor or tuberous sclerosis in 8% each. At last follow-up (median 4.3, range 1-14.3 yr), 60% of children remained seizure-free: 38% had discontinued antiepileptic drugs. Intralobar lesionectomy resulted more often in seizure control than multilobar or hemispheric surgery. Postsurgical seizure freedom was determined by the completeness of resection. Early postsurgical seizures were key markers of seizure recurrence. Presurgical adaptive and cognitive developmental status was impaired in 89% children. Longer epilepsy duration and larger lesion extent were detrimental to presurgical development, which, in turn, determined the postsurgical developmental outcome. CONCLUSION: Our study demonstrates that epilepsy surgery in very young children is safe as well as efficient regarding long-term seizure freedom and antiepileptic drug cessation in selected candidates. Longer epilepsy duration is the only modifiable predictor of impaired adaptive and cognitive development, thus supporting early surgical intervention.
Authors: Lara Jehi; Nathalie Jette; Churl-Su Kwon; Colin B Josephson; Jorge G Burneo; Fernando Cendes; Michael R Sperling; Sallie Baxendale; Robyn M Busch; Chahnez Charfi Triki; J Helen Cross; Dana Ekstein; Dario J Englot; Guoming Luan; Andre Palmini; Loreto Rios; Xiongfei Wang; Karl Roessler; Bertil Rydenhag; Georgia Ramantani; Stephan Schuele; Jo M Wilmshurst; Sarah Wilson; Samuel Wiebe Journal: Epilepsia Date: 2022-07-17 Impact factor: 6.740
Authors: Dorottya Cserpan; Ece Boran; Santo Pietro Lo Biundo; Richard Rosch; Johannes Sarnthein; Georgia Ramantani Journal: Brain Commun Date: 2021-03-23