Favorable Seizure and Developmental Outcome with Thorough Noninvasive Evaluation in Pediatric Epilepsy Surgery: A Single-epilepsy-center Retrospective Study of 134 Patients
Abstract number :
1.452
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
1291
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Taro Okumura, MD – NHO Shizuoka Institute of Epilepsy and Neurological Disorders
Naotaka Usui, MD,PhD – NHO Shizuoka Institute of Epilepsy and Neurological Disorders
Hiroshi Ogawa, MD,PhD – NHO Shizuoka Institute of Epilepsy and Neurological Disorders
Mitsuru Hashiguchi, MD,PhD – NHO Shizuoka Institute of Epilepsy and Neurological Disorders
Katsumi Imai, MD – NHO Shizuoka Institute of Epilepsy and Neurological Disorders
Rationale: We performed thorough noninvasive presurgical evaluations in epilepsy surgery candidates. We assessed the seizure and developmental outcomes of a large number of patients who underwent pediatric epilepsy surgery in our institute to clarify the appropriateness of our strategy.
Methods: 134 pediatric patients who underwent epilepsy surgery under 15 years old, and were followed for at least 2 years were included. The results of presurgical evaluations, postoperative seizure outcomes, and developmental outcomes were retrospectively investigated, and the prognostic factors including etiology were examined. We defined Engel class I as a favorable outcome, and Engel class Ⅱ-Ⅳ as an unfavorable outcome. Preoperative and postoperative (2 years after surgery) DQ/IQ was used for the assessment of the developmental outcome. We analyzed the factors influencing seizure and developmental outcomes using t-test and multivariate regression analysis.
Results: MRI was positive in 129 patients (95.6%). FDG-PET revealed concordant findings in 118/131 patients (90.1%). Ictal SPECT was performed in 90 patients (67.2%), and provided concordant information in 84/90 patients (93.3%). Intracranial EEG was performed in only 11/134 patients (8.2%). 94/134 (70.1%) were seizure free 2 years postoperatively. There were no significant differences in seizure outcome by sex, age at primary surgery, duration of epilepsy, and operated side. The factors for a favorable seizure outcome were the following: temporal lobe surgery, FCD type II, and hippocampal sclerosis. The factors for an unfavorable outcome were the following: extratemporal lobe surgery, daily seizures, pre IQ/DQ< 70, spasms, and FCD type I. 108 patients underwent developmental evaluation preoperatively and 2 years after surgery. The mean IQ change was +1.3 points, and the mean DQ change was +1.0 points. Mean DQ significantly improved in extratemporal lobe surgery (multivariate regression analysis, p >0.05), and mean DQ significantly decreased in patients with spasms (multivariate regression analysis, p >0.01). DQ tended to improve in patients with FCD type II. (t-test, p >0.05)
Conclusions: Thorough noninvasive presurgical evaluations enabled curative epilepsy surgery without intracranial EEG in most of our patients and lead to favorable seizure and developmental outcomes.
Funding: The authors have no financial or proprietary interests in any material discussed in this article.
Surgery