Abstracts

Rationale: Epilepsy is a common disorder affecting the pediatric population. Approximately one third of children with epilepsy have medically intractable seizures and may be candidates for epilepsy surgery. Some of these surgical candidates may have other common disorders such as bleeding diatheses. Although epilepsy surgery carries a relatively low risk of bleeding during the perioperative period; that risk is considerably increased when children have a concurrent bleeding diathesis. There is a paucity of data in the literature about epilepsy surgical complications and outcome in patients with comorbid coagulopathies.Methods: We performed a retrospective chart review of all children (age: 0-18 years) who were candidates for resective epilepsy surgery (2003-2011) and were included in the epilepsy surgery database at Texas Children s Hospital. We further identified the subgroup of children with bleeding diatheses from the database. The clinical and demographic features, diagnostic tests, consult reports, complications, and treatment responses were analyzed.Results: A total of 10 patients were identified; two underwent evaluation, but did not have surgery. For the remaining 8 patients who had surgery, there were 4 males (50%) and 4 females (50%)] with a mean age of 13.7 (range: 7-22) years. All patients had symptomatic localization-related epilepsy (SLRE). The mean duration of epilepsy was 6.8 years (range: 20 months to 15 years). The seizure types were either complex partial [4(50%)] or simple partial [4(50%)] with or without secondary generalization. One patient (12%) had a hemolytic process (auto immune hemolytic anemia). Three patients (37%) had factor deficiencies; one with factor VII/X associated with thrombocytopenia, one with factor VIII and the other one with congenital factor XII deficiency. In the remaining patients, one was diagnosed with Von Willebrand disease type 1, one patient had abnormal coagulation panel with unknown significance and one patient had very low platelets due to medication effect (valproic acid). Three patients (37%) underwent anterior temporal lobectomies, 2 (25%) had functional hemispherectomies, 2 (25%) with lesionectomies, and one had a right anatomic hemispherectomy. Six patients (75%) had a surgical outcome classified as Engel type I and one (12%) had an Engel type II. In five (62%) patients, the pathology revealed cortical dysplasia, 2 (25%) had mesial temporal sclerosis, and one had gliosis secondary to a remote infarct. All patients underwent hematology evaluation preoperatively and with a close teamwork with hematology service; perioperative measures were taken to correct the diagnosed coagulopathy. All patients were evaluated pre and immediately post-operatively with no significant complications.Conclusions: Our clinical experience in patients with coagulopathy in a single tertiary care center reveals that 87% of patients had Engel type I or II outcome with no significant bleeding complications in the perioperative period. Bleeding diathesis does not preclude from epilepsy surgery in children with intractable epilepsy.