Epilepsy surgery failure in children: A quantitative and qualitative analysis

Dario J. Englot, Seunggu (Jude) Han, John D. Rolston, Michael E. Ivan, Rachel A. Kuperman, Edward F. Chang, Nalin Gupta, Joseph E. Sullivan, Kurtis I. Auguste

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Object. Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear.

Methods. The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted.

Results. Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II-IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%).

Conclusions. While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.

Original languageEnglish (US)
Pages (from-to)386-395
Number of pages10
JournalJournal of Neurosurgery: Pediatrics
Volume14
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Epilepsy
Seizures
Hemispherectomy
Pediatrics
Malformations of Cortical Development
Partial Epilepsy
Sclerosis
Temporal Lobe
Reoperation
Neuroimaging
Statistical Factor Analysis
Counseling
Cohort Studies
Retrospective Studies
Pathology
Therapeutics
Neoplasms

Keywords

  • Epilepsy surgery
  • Focal cortical dysplasia
  • Mesial temporal sclerosis
  • Recurrence
  • Seizure outcome

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Englot, D. J., Han, S. J., Rolston, J. D., Ivan, M. E., Kuperman, R. A., Chang, E. F., ... Auguste, K. I. (2014). Epilepsy surgery failure in children: A quantitative and qualitative analysis. Journal of Neurosurgery: Pediatrics, 14(4), 386-395. https://doi.org/10.3171/2014.7.PEDS13658

Epilepsy surgery failure in children : A quantitative and qualitative analysis. / Englot, Dario J.; Han, Seunggu (Jude); Rolston, John D.; Ivan, Michael E.; Kuperman, Rachel A.; Chang, Edward F.; Gupta, Nalin; Sullivan, Joseph E.; Auguste, Kurtis I.

In: Journal of Neurosurgery: Pediatrics, Vol. 14, No. 4, 01.01.2014, p. 386-395.

Research output: Contribution to journalArticle

Englot, DJ, Han, SJ, Rolston, JD, Ivan, ME, Kuperman, RA, Chang, EF, Gupta, N, Sullivan, JE & Auguste, KI 2014, 'Epilepsy surgery failure in children: A quantitative and qualitative analysis', Journal of Neurosurgery: Pediatrics, vol. 14, no. 4, pp. 386-395. https://doi.org/10.3171/2014.7.PEDS13658
Englot, Dario J. ; Han, Seunggu (Jude) ; Rolston, John D. ; Ivan, Michael E. ; Kuperman, Rachel A. ; Chang, Edward F. ; Gupta, Nalin ; Sullivan, Joseph E. ; Auguste, Kurtis I. / Epilepsy surgery failure in children : A quantitative and qualitative analysis. In: Journal of Neurosurgery: Pediatrics. 2014 ; Vol. 14, No. 4. pp. 386-395.
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abstract = "Object. Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear.Methods. The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted.Results. Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76{\%} of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II-IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40{\%}), an additional epileptogenic zone distant from the resection cavity (32{\%}), and the presence of a hemispheric epilepsy syndrome (28{\%}).Conclusions. While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.",
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AU - Kuperman, Rachel A.

AU - Chang, Edward F.

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AU - Sullivan, Joseph E.

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N2 - Object. Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear.Methods. The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted.Results. Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II-IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%).Conclusions. While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.

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