Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections
| Autor: | Eva Martinez-Lizana, Gert Wiegand, Mukesch Shah, Josef Zentner, Susanne Fauser, Soroush Doostkam, Andreas Schulze-Bonhage, Julia Jacobs, Victoria San Antonio-Arce, Thomas Bast, Armin Brandt, Elisabeth Schuler |
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| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Adolescent Intractable epilepsy Neurosurgical Procedures Cohort Studies 03 medical and health sciences Epilepsy 0302 clinical medicine Recurrence medicine Seizure control Humans Epilepsy surgery Child business.industry Infant Newborn Infant Seizure outcome Electroencephalography Retrospective cohort study General Medicine Cortical dysplasia medicine.disease Magnetic Resonance Imaging Surgery Treatment Outcome 030104 developmental biology Neurology Child Preschool Malformations of Cortical Development Group I Cohort Anticonvulsants Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Seizure. 62:66-73 |
| ISSN: | 1059-1311 |
| DOI: | 10.1016/j.seizure.2018.09.021 |
| Popis: | Purpose Focal cortical dysplasia (FCD) is the major cause of focal intractable epilepsy in childhood. Here we analyze the factors influencing the success of surgical treatment in a large cohort of children with histologically ascertained FCD. Method A retrospective study of the effects of FCD type, surgical intervention, and age at surgery in a pediatric cohort. Results A total of 113 patients (71 male; mean age at surgery 10.3 years; range 0–18) were analyzed; 45 had undergone lesionectomy, 42 lobectomy, 18 multi-lobectomy, and eight hemispherotomy. Complete seizure control (Engel Ia) was achieved in 56% after two years, 52% at five years, and 50% at last follow-up (18–204 months). Resections were more extensive in younger patients (40% of the surgeries affecting more than one lobe in patients aged nine years or younger vs. 22% in patients older than nine years). While resections were more limited in older children, their long-term outcome tended to be superior (42% seizure freedom in patients aged nine years or younger vs. 56% in patients older than nine years). The outcome in FCD I was not significantly inferior to that in FCD II. Conclusions Our data confirm the long-term efficacy of surgery in children with FCD and epilepsy. An earlier age at surgery within this cohort did not predict a better long-term outcome, but it involved less-tailored surgical approaches. The data suggest that in patients with an unclear extent of the dysplastic area, later resections may offer advantages in terms of the precision of surgical-resection planning. |
| Databáze: | OpenAIRE |
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