Cortical Dyplasia in Pediatric Epilepsy, Patient Selection and Outcome after Resective Surgery
Abstract number :
2.284
Submission category :
Year :
2001
Submission ID :
674
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
K.C. Ess, MD, PhD, Pediatric Neurology, St. Louis Children's Hospital and Wash. Univ., St. Louis, MO; L.L. Thio, MD, PhD, Pediatric Epilepsy, St. Louis Children's Hospital and Wash. Univ., St. Louis, MO; J.G. Ojemann, MD, Pediatric Neurosurgery, St. Louis
RATIONALE: Increasing emphasis is being placed on the surgical management of pediatric patients with intractable epilepsy. Developmental anomalies of the cerebrum such as focal cortical dysplasia are emerging as important etiologies for intractable seizures. With current MRI sensitivity, more pediatric patients are being evaluated for epilepsy surgery. When appropriately selected, these patients may benefit from resection of abnormal cerebral cortex.
METHODS: Pathologic specimens of all patients who underwent epilepsy surgery at St. Louis Children[ssquote]s Hospital were analyzed for cortical dysplasia. Patient[ssquote]s age of seizure onset, age of surgery, and gender were then evaluated. All patients had at least 6 months of follow-up for seizure frequency.
RESULTS: 23 patients (13 females) of 118 patients who have undergone epilepsy surgery at St. Louis Children[ssquote]s Hospital from 1994-2001 had pathological evidence of cortical dysplasia. Duration of follow-up after surgery ranged from 6 months to 13 years. Age at surgery ranged from 4 months - 19 years. Age of onset of seizures ranged from less than 2 weeks to 10 years. Duration of seizures before surgical intervention ranged between 2 months to 15 years. 21 of 23 patients (91%) had a pre-operative MRI that demonstrated abnormalities consistent with dysplasia in the epileptogenic zone. 14 of 23 patients had the area of dysplasia confined to a single lobe. 3 patients underwent a hemispherectomy, 10 underwent an extratemporal focal cortical resection, 4 underwent a temporal lobectomy, and 6 had resections of more than one lobe. 13 of 22 patients (59%) were seizure free (Engel Class I), an additional 2 patients had [gt] 90% reduction in seizure frequency (Engel Class II), 3 patients had 50-90% reduction in seizure frequency (Engel Class III) and 4 patients had no worthwhile improvement. One patient who underwent a hemispherectomy 8 months prior to abstract submission has not kept post-op follow-up appointments. No patient was clearly worse in terms of seizure frequency after surgery.
CONCLUSIONS: Carefully selected pediatric patients with cortical dysplasia and intractable epilepsy can have good surgical outcomes.