Outcome Following Frontal Lobe Epilepsy Surgery in Children.
Abstract number :
2.279
Submission category :
Year :
2001
Submission ID :
2021
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S.T. Arnold, MD, Neurology, Washington University, St Louis, MO; E. Trevathan, MD, MPH, Neurology, Washington University, St Louis, MO; L.L. Thio, MD, PhD, Neurology, Washington University, St Louis, MO; J.G. Ojemann, MD, Neurology, Washington University,
RATIONALE: To better define the outcome following pediatric frontal lobe epilepsy surgery, results were reviewed for all children undergoing frontal lobe surgery at the Pediatric Epilepsy Center at Saint Louis Children[ssquote]s Hospital.
METHODS: Retrospective chart review was performed for all patients undergoing frontal lobe epilepsy surgery at Saint Louis Children[ssquote]s Hospital from 1994-2001. Cases with at least 6 months of follow up (mean = 2.4 years) were included.
RESULTS: 25 procedures were performed on 23 patients. (2 children had repeat surgery.) Age at surgery was 3 months to 19 years (mean = 10 years). 19 cases had monitoring with subdural electrodes. 1 had multiple subpial transection with only minimal resection. 15 had a defined structural lesion. Preoperative seizure frequency ranged from 20/day to 1/week (mean = 4/day). In 12 cases surgery resulted in complete seizure control or rare, simple partial seizures (Engel Class I). 2 had [gt]95% seizure reduction with less than 5/year (Class II). 8 had [gt]50% seizure reduction with a median of 4/week (Class III). 3 had no sustained improvement (Class IV); 2 of these had repeat surgery and improved to Classes I and III. Of 15 cases with a structural lesion, 66% had a Class I outcome vs. 20% of non-lesional cases (p=0.022). Combining Classes I and II, 66% of lesional and 40% of non-lesional surgery had a favorable outcome. Complete resection of a defined lesion or epileptogenic zone was associated with better seizure control, with 56% vs. 33% Class I outcome. In 5 patients with severely disabling epilepsy, the planned resection included areas of motor cortex. Residual motor disability was mild or moderate and limited to one limb as predicted based on presurgical mapping. 2 of these 5 children became seizure free, both with cortical dysplasia (one not identified until after surgery). The remaining 3 (non-lesional) had Class III outcomes with mean seizure reduction of 80%.
CONCLUSIONS: Following frontal lobe epilepsy surgery about half of children were seizure free or had a Class I outcome. Outcome was significantly better when a structural lesion was present, and tended to be improved when the entire epileptogenic zone was resected. All 5 patients with a planned resection of primary motor cortex improved, and 2 became seizure free. For some patients with severely disabling seizures, extending surgery to include motor cortex allows more complete resection of the epileptogenic zone and may improve seizure control, with limited functional disability. Further follow up is needed to define long term outcome for this group.