Journal
NEUROLOGY
Volume 74, Issue 22, Pages 1768-1775Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3181e0f17a
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Funding
- NIH [R01 NS38992]
- CAPES [2503-08-5]
- CNPq [201031/2008-6]
- Dalyit S. and Flaine Sarkaria Chair in Diagnostic Medicine
- Brazilian government (CAPES) [2503-08-5]
- Brazilian government (CNPq) [201031/2008-6]
- Novartis
- NIH/NINDS [K23 NS051637, NS046516, NS045911, NS059505, MH079933, RO1 NS 38992]
- Thrasher Research Fund
- Lundbeck Inc.
- Ortho-McNeil-Janssen Pharmaceuticals, Inc.
- NeuroTherapeutics Pharma, Inc.
- Valeant Pharmaceuticals International
- Marinus Pharmaceuticals, Inc.
- Epilepsy Foundation of America
- American Society of Neuroradiology Research Foundation
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Objective: Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time. Methods: Pediatric epilepsy surgery patients operated in the first 11 years (1986-1997; pre-1997) were compared with the second 11 years (1998-2008; post-1997) for differences in presurgical and postsurgical variables. Results: Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, +16%), 1 (81%, +18%), 2 (77%, +19%), and 5 (74%, +29%) years, and more seizure-free patients were on medications at 0.5 (97%, +6%), 1 (88%, +9%), and 2 (76%, +29%), but not 5 (64%, +8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery. Conclusions: Improved technology and surgical procedures along with changes in clinical practice were likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients. Neurology(R) 2010;74:1768-1775
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