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  • Big Brain-Surgery for Little People: Initial Challenges of an EpilepsyTeam

    Final Number:
    1623

    Authors:
    Abhaya Kumar MBBS, MS, FRCS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Paediatric Epilepsy Surgery is very complex. A 2-stage pre-surgical evaluation is indicated for patients whose epileptogenic zone needs delineation from eloquent cortex and in patients with multiple lesions. We highlight the outcomes and challenges of the team in developing these tailored treatments.

    Methods: Prospective study from 2013 to 2016. 12 patients who had minimum follow-up of 6 months were included Another subset of 6 patients was identified - needed 2-stage surgery underwent 1-stage epilepsy surgery . In most patients multimodality pre-surgical evaluation techniques and intra-operative monitoring including awake surgery were used Clinical characteristics/ Types of surgery/ Engel class outcomes were evaluated

    Results: Total number of patients is 12.Male to female ratio 10:2. 1/3 patients had 2 types of seizure Second type of seizures were dialeptic or focal On an average the patients were on 3 anti-epileptics with poor seizure control Surgical substrates were: Isolated MTS - 2 MTS Plus - 3 FCD - 7 Multilesional perinatal injury - 2 Congenital developmental malformations - 3 5 patients had Lesionectomy. 4 patients had Temporal Lobectomy with AH. 2 patients had Extratemporal Lobectomy. 1 patients had TPO Disconnection and Functional Hemisphereotomy. Two patients (<2yrs) developed pseudomeningocele one patient each developed Lt. hemiparesis and Meningitis. Three (25%) patients had breakthrough seizures within 6 months of surgery and one patient had epileptic episode after 2 years- from a different lesion. A patient with Mesial Temporal Sclerosis has Engel Class II and another with Frontal Dysplasia is Engel Class III. Eight (67%) patients are completely seizure free till date In subset of 6 patients- 4 are seizure free (Class Ia)

    Conclusions: Application of western paradigms of epilepsy surgery is not possible to a large subset of our patients. This small case series makes us hopeful that we may be able to develop approaches avoiding two-stage (invasive monitoring) procedures in a carefully chosen subset of patients. It may make paediatric epilepsy surgery more acceptable, affordable and accessible to the masses.

    Patient Care: Unnecessary SEEG can be avoided in some patients. Decrease cost by avoiding 2 stage procedure.

    Learning Objectives: Understanding the different types of pediatric epilepsy patients. Different surgical Substrate. SEEG can be avoided in some patients. Single stage surgery is possible in Pediatric epilepsy patients.

    References:

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