Introduction: Pediatric epilepsy is a prevalent neurologic condition with annual incidence of 50 per 100,000. Despite major strides in the medical management of epilepsy, a large percentage of children continue to experience medically intractable seizures and associated morbidities; surgical management is their last resort for seizure control and better quality of life. Surgical intervention requires a comprehensive team approach involving trained epileptologists, EEG technologists, expert neurosurgeons, and support staff in addition to specialized equipment. Hence, the goal of our research was to establish whether our young center is efficient at alleviating this common pediatric malady.
Methods: A retrospective chart review of epilepsy surgery was performed between 2005and2014 at Children’s Hospital in New Orleans. The cohort consisted of patients < 21 years of age who underwent surgical resection and at least 1 year of follow up (n = 33). Outcomes were based on postoperative Engel score, medications, and neurocognitive testing, as compared to age of onset, pre-operative Engel score and cognitive impairment, location, and histopathology.
Results: Our cohort consisted of 33 patients who underwent single or two-stage surgery with grid placement and epileptogenic focus resection. Majority of the surgeries were two-stage procedures. Temporal lobectomies were prevalent (42%), followed by frontal lobe resections (18%). Focal cortical dysplasia was the most common pathology (59% of cases). The Engel classification was used to measure outcome with 72% of our patient population achieving Engel Class I, 12% Engel II, and 15% Engel III. There were no Engel Class IV patients.
Conclusions: Epilepsy surgery is an effective tool for patients with identifiable focal lesions. Significant improvement can be achieved through the use of an individualized and multidisciplinary team approach. There is a low complication and high satisfaction rate with significant improvement in the number and frequency of seizures, even in a newly established epilepsy center.
Patient Care: Our research will set precedence for newly developing epilepsy surgery centers around the country and the world. It will provide the basic building blocks, challenges and results that one will encounter at the beginning stages of establishing a comprehensive epilepsy surgery center.
Learning Objectives: Determine the correlation between pre- and perioperative variables on the outcome of children undergoing surgery for medically intractable seizures and the efficacy of our budding epilepsy center.
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Simpson et al. Post-surgical outcome for epilepsy associated with type I focal cortical dysplasia subtypes. Mod Pathol. 27 (11): 1455-60. Nov 2014.
Asadi-Pooya et al. Management of epilepsy in resource-limited areas: establishing an epilepsy surgery program in Iran. Med J Islam Republic Iran, 28 (1): 24. Mar 2014.
Cataltepe et al. Pediatric Epilepsy Surgery, 2010, p. 1