Abstracts

RATIONALE: Children with severe epilepsy are often mentally retarded. In the majority of these patients epilepsy is drug resistant and epilepsy surgery (ES) may offer a solution. However, it is said that the efficacy of ES with regard to seizure reduction is unpredictable in patients with intractable epilepsy and mental retardation (MR), due to the diffuse character of the underlying brain disorder (1). Therefore, in many centers children with MR are considered to be unfeasible for ES. The aim of this study was to assess the value of ES in these children in terms of both seizure reduction and quality of life.
METHODS: 12 children suffering from drug resistant epilepsy with an IQ [lt] 70 were studied. Hemispherectomy was performed in 5; callosotomy in 2 and resection in 5 patients. Postoperative seizure control was expressed in the Engel classification. Quality of life was assessed by retrospective file analysis focussed on the domains of self-care, mobility, cognitive and emotional functioning, well-being and health and social interaction, as well as by validated structured interviews. Follow-up was at least two years.
RESULTS: Seizure control: Engel 1A was found in 8; Engel 2A in 2 and Engel 3 in 2 patients. Comparison of postoperative IQ with preoperative IQ did not show any improvement nor deterioration. In the two patients with Engel 3 (both treated with callosotomy) no improvement of quality of life was found. In the other 10, quality of life measurements showed an impressive improvement post-surgery in all domains.
CONCLUSIONS: Seizure control and quality of life significantly improved after epilepsy surgery in patients with mental retardation. In our opinion children with drug resistant epilepsy should be considered for ES, regardless of their IQ.
1. Engel Jjr. Shewmon DA: Overview: Who should be considered a surgical candidate, in Engel Jjr (ed): Surgical Treatment of the Epilepsies (ed 2). New York, NY, Raven, 1999, pp. 23-24.