Long-term Functional and Seizure Outcome in Children Following Posterior Cortex Resection
Abstract number :
1.335
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204618
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Elham Abushanab, MD – Cleveland Clinic; Nicolas Thompson, -- – Cleveland Clinic; Elia Pestana-Knight, MD – Cleveland Clinic; Deepak Lachhwani, MD – Cleveland Clinic; Prakash Kotagal, MD – Cleveland Clinic; Elaine Wyllie, MD – Cleveland Clinic; Ajay Gupta, MD – Cleveland Clinic; William Bingaman, MD – Cleveland Clinic; Ahsan Moosa Naduvil Valappil, MD – Cleveland Clinic
Rationale: Data on functional outcome after posterior cortex epilepsy surgery in children are limited. Our aim was to examine the long-term seizure outcome and functional outcome in children who had occipital or occipital-plus resections.
Methods: We reviewed 102 children who underwent occipital or occipital-plus (occipital-temporal, occipital-parietal, temporal-parietal-occipital) resections between 2000 and 2020. Fifty-one families completed a questionnaire to assess the functional status in speech, reading ability, and school placement.
Results: The mean age at onset of epilepsy was 2 years while mean age at time of surgery was 5.4 years. The majority of patients (71%) suffered from severe epilepsy with daily seizures. The most common MRI brain abnormality included malformation of cortical development (54%) with the next most common cause being an acquired injury, usually perinatal. Of the 102 patients, 61 (60%) had a favorable outcome (45 Engel I, 16 Engel II) and 41 (39%) had an unfavorable seizure outcome (26 Engel III, 15 Engel IV). 50% of patients had an Engel I at 1 and 2 year follow-up which dropped to 40% at 3 years and 32% at 5 years. Nearly 70% of patients who had seizure recurrence following surgery experienced this within the first year, 54% by the first 6 months and 34% within the first week post-surgery. When divided by surgery, patient with occipital and occipital temporal surgery had the best outcome with Engel I outcome in 82% and 69%, respectively. Only 20% and 40% of patients with occipital parietal and temporal-parietal-occipital resection had an Engel I outcome, respectively. On multivariate analysis the following predicted poor seizure outcome: daily seizures, multi-lobar lesions with contralateral hemispheric involvement on MRI, occipital-parietal or temporal-parietal-occipital resections, non-tumor pathology, and acute post-operative seizures. Of 51 patients who completed the questionnaire, speech was age appropriate in 45%; 24% had mild delay, 12% had moderate delay, and 20% had minimal words or were nonverbal. In school aged children, reading was age appropriate in 31%; 35% were reading below their grade level, 27% were able to recognize alphabet/numbers or a few words, and 7% were unable to read. 80% attended regular school with two-third requiring assistive services, and 20% were in a special-education school. Older age at onset of seizures and normal development or language prior to surgery were significantly associated with favorable outcome in all three functional measures. Interictal and ictal changes unilateral to surgery was associated with a favorable outcome for both speech and reading. The side of surgery had no impact on outcome.
Conclusions: Children with occipital or occipitotemporal epilepsy had better seizure outcome; involvement of parietal lobe may indicate a wider epileptogenic zone. More than two-third of children with occipital or occipital-plus resection had reading difficulties at follow up. Early age at seizure onset, pre-existing developmental delay, and EEG abnormalities in both hemispheres are associated with poor functional outcome in speech and reading.
Funding: None
Surgery