Objectives: Surgery represents an additional therapeutic option for drug resistant focal epilepsies in childhood. The results of surgical procedures for epilepsy performed on 100 children are presented.
Material and Methods: Between January 1998 and July 2004, epilepsy surgery was performed on 100 children between 1–16 years of age. Demographical data, etiology of the epilepsy, results of video-EEG telemetry, localization and type of surgery were documented and analyzed. The seizure outcome was determined at fixed intervals 6, 12, 18, 24, 36, 48, and 60 months after surgery and classified according to Engel et al.
Results: Before surgery, all children were evaluated with non-invasive long-term video-EEG telemetry, 33 children had additional invasive monitoring with implanted electrodes, 26 children had intraoperative electrocorticography. A cortical resection±amygdalohippocampectomy (AHE) was performed on 91 children, 4 had a selective AHE and 4 had a functional hemispherectomy. One patient had only multiple subpial transections. The localization was temporal in 46, monolobar extratemporal in 29 and multilobar/hemispheric in 25 patients. The etiology of the epilepsy was cortical dysplasia in 56, tumor in 24, (perinatal) ischemia in 6, tuberous sclerosis in 4, Rasmussen's encephalitis in 2 and various other in 8 children. Unexpected postoperative permanent neurological deficits were seen only in 3 patients (2 pareses, 1 partial aphasia).
Depending on the point of observation during follow-up, about 70% of children were completely free of seizures, up to 8% had only non-disabling simple partial seizures, about 10% had rare disabling seizures. Only 4–12% of patients did not improve after surgery. Temporal resections had the best outcome; there were no significant differences regarding the etiology. While some patients had seizure recurrences even several years after surgery, the overall outcome remained stable over time.
Conclusions: Our results confirm the validity of surgical therapy for drug-resistant focal epilepsies in childhood.
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Outcome after
|
6
|
12
|
18
|
24
|
36
|
48
|
60 months
|
|
Engel et al.
|
|
|
|
|
|
|
|
|
Class Ia
|
72%
|
68%
|
68%
|
69%
|
71%
|
75%
|
75%
|
|
I total
|
80%
|
74%
|
74%
|
76%
|
75%
|
80%
|
75%
|
|
II
|
11%
|
10%
|
9%
|
9%
|
10%
|
10%
|
0
|
|
III
|
4%
|
12%
|
13%
|
10%
|
10%
|
0
|
12.5%
|
|
IV
|
5%
|
4%
|
4%
|
5%
|
5%
|
10%
|
12,5%
|
|
Number of patients
|
100
|
85
|
69
|
59
|
41
|
20
|
8
|
