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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Multilobar epilepsy surgery in childhood and adolesence: predictors of long-term seizure outcome

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  • Evangelos Kogias - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Thomas Bast - Epilepsiezentrum Kork, Kehl-Kork, Deutschland
  • Susanne Schubert-Bast - Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Heidelberg, Deutschland
  • Gert Wiegand - Universitätsklinikum Schleswig-Holstein, Klinik für Neuropädiatrie, Kiel, Deutschland
  • Rudolf Korinthenberg - Universitätsklinikum Freiburg, Klinik für Neuropädiatrie und Muskelerkrankungen, Freiburg, Deutschland
  • Andreas Schulze-Bonhage - Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Deutschland
  • Josef Zentner - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Georgia Ramantani - Universitätsklinikum Freiburg, Epilepsiezentrum, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV174

doi: 10.3205/18dgnc177, urn:nbn:de:0183-18dgnc1779

Published: June 18, 2018

© 2018 Kogias et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To investigate the long-term seizure outcome of children and adolescents undergoing multilobar epilepsy surgery and determine their predictive factors.

Methods: We retrospectively analyzed the data of 69 consecutive patients aged 10.0 ± 5.0 years at surgery. All but two patients had an MRI-visible lesion. Resections were temporo-parieto(-occipital) in 23 (33%), parieto-occipital in 11 (16%), temporo-occipital in 28 (41%), and fronto-temporo(-parietal) in 7 (10%) cases. Etiology included focal cortical dysplasia in 67%, peri- or postnatal ischemic lesions in 23%, and benign tumors in 10% cases.

Results: At last follow-up (median 9 years, range 2.8-14.8), 33 (48%) patients remained seizure free (Engel I); 23 (33%) had discontinued antiepileptic drugs. 7 (10%) patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Most seizure recurrences (80%) occurred within the first 6 months, and only 4 patients presented with seizures ≥2 years after surgery. Of presurgical variables, only an epileptogenic zone and/or lesion distant from eloquent cortex correlated with significantly higher rates of seizure freedom. Of postsurgical variables, the completeness of resection and the lack of early postsurgical seizures correlated with significantly higher rates of seizure arrest.

Conclusion: Our study demonstrates that multilobar epilepsy surgery is effective in terms of lasting seizure control and antiepileptic drug cessation in selected pediatric candidates. Lesions that localize distant from eloquent cortex and can thus be fully resected, predispose to favorable outcomes regarding seizure freedom. Early postsurgical seizures are not benign, but constitute key markers of seizure recurrence that should prompt timely reevaluation.