Surgery in patients with childhood-onset epilepsy: analysis of complications and predictive risk factors for a severely complicated course

Autor: Massimo Cossu, Lino Nobili, Michele Rizzi, Giorgio Lo Russo, Francesco Cardinale, Michele Nichelatti, Valeria Mariani, Piergiorgio d'Orio, Veronica Pelliccia
Rok vydání: 2018
Předmět:
Adult
Male
Reoperation
Drug Resistant Epilepsy
Microsurgery
medicine.medical_specialty
Multivariate analysis
Adolescent
complications
medicine.medical_treatment
childhood-onset epilepsy
Neurosurgical Procedures
Young Adult
03 medical and health sciences
Epilepsy
Postoperative Complications
0302 clinical medicine
Risk Factors
medicine
Humans
Epilepsy surgery
Young adult
Child
Electrocorticography
Retrospective Studies
medicine.diagnostic_test
business.industry
Age Factors
Infant
Retrospective cohort study
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Surgery
Psychiatry and Mental health
Child
Preschool
childhood-onset epilepsy
complications
epilepsy
epilepsy surgery
Cohort
epilepsy surgery
epilepsy
Female
Epilepsies
Partial
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: Journal of Neurology, Neurosurgery & Psychiatry. 90:84-89
ISSN: 1468-330X
0022-3050
DOI: 10.1136/jnnp-2018-318282
Popis: ObjectTo compare the occurrence of surgery-related complications in patients with childhood-onset focal epilepsy operated on in the paediatric or in the adult age. To investigate risk factors for surgery-related complications in the whole cohort, with special attention to age at surgery and severe morbidity.MethodsA cohort of 1282 patients operated on for childhood-onset focal epilepsy was retrospectively analysed. Occurrence of surgery-related complications, including a severely complicated course (SCC: surgical complication requiring reoperation and/or permanent neurological deficit and/or death), was compared between patients operated on in the paediatric age (ResultsAt last contact (median follow-up 98 months), 74.5% of patients were in Engel’s class I (78.0% of children and 73.0% of adults). One hundred patients (7.8%) presented a SCC (6.4% for children and 8.6% for adult patients). Postoperative intracranial haemorrhages occurred more frequently in adult cases. At multivariate analysis, increasing age at operation, multilobar surgery, resections in the rolandic/perirolandic and in insulo-opercular regions were independent risk factors for a SCC.ConclusionsSurgery for childhood-onset focal epilepsy provides excellent results on seizures and an acceptable safety profile at any age. Nevertheless, our results suggest that increasing age at surgery is associated with an increase in odds of developing severe surgery-related complications. These findings support the recommendation that children with drug-resistant, symptomatic (or presumed symptomatic) focal epilepsy should be referred for a surgical evaluation as early as possible after seizure onset.
Databáze: OpenAIRE
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