Epilepsy surgery failure in children: a quantitative and qualitative analysis

Clinical article

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  • 1 UCSF Comprehensive Epilepsy Center and 
  • 2 Departments of Neurological Surgery,
  • 3 Neurology, and
  • 4 Pediatrics, University of California, San Francisco; and
  • 5 Pediatric Epilepsy Program, Children's Hospital and Research Center Oakland, California
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Object

Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear.

Methods

The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted.

Results

Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II–IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%).

Conclusions

While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.

Abbreviations used in this paper:CHRCO = Children's Hospital and Research Center Oakland; ECoG = electrocorticography; EEG = electroencephalography; FCD = focal cortical dysplasia; MCD = malformation of cortical development; MTS = mesial temporal sclerosis; TLE = temporal lobe epilepsy; UCSF = University of California, San Francisco.

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Contributor Notes

Address correspondence to: Dario J. Englot, M.D., Ph.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Box 0112, San Francisco, CA 94143-0112. email: englot@gmail.com.

Please include this information when citing this paper: published online August 15, 2014; DOI: 10.3171/2014.7.PEDS13658.

  • 1

    Akiyama T, , McCoy B, , Go CY, , Ochi A, , Elliott IM, & Akiyama M, : Focal resection of fast ripples on extraoperative intracranial EEG improves seizure outcome in pediatric epilepsy. Epilepsia 52:18021811, 2011

    • Search Google Scholar
    • Export Citation
  • 2

    Asano E, , Juhász C, , Shah A, , Sood S, & Chugani HT: Role of subdural electrocorticography in prediction of long-term seizure outcome in epilepsy surgery. Brain 132:10381047, 2009

    • Search Google Scholar
    • Export Citation
  • 3

    Barba C, , Montanaro D, , Frijia F, , Giordano F, , Blümcke I, & Genitori L, : Focal cortical dysplasia type IIb in the rolandic cortex: functional reorganization after early surgery documented by passive task functional MRI. Epilepsia 53:e141e145, 2012

    • Search Google Scholar
    • Export Citation
  • 4

    Bauman JA, , Feoli E, , Romanelli P, , Doyle WK, , Devinsky O, & Weiner HL: Multistage epilepsy surgery: safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy. Neurosurgery 62:Suppl 2 489505, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Bettus G, , Wendling F, , Guye M, , Valton L, , Régis J, & Chauvel P, : Enhanced EEG functional connectivity in mesial temporal lobe epilepsy. Epilepsy Res 81:5868, 2008

    • Search Google Scholar
    • Export Citation
  • 6

    Blümcke I, , Thom M, , Aronica E, , Armstrong DD, , Vinters HV, & Palmini A, : The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 52:158174, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    Breyer T, , Wanke I, , Maderwald S, , Woermann FG, , Kraff O, & Theysohn JM, : Imaging of patients with hippocampal sclerosis at 7 Tesla: initial results. Acad Radiol 17:421426, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Carlson C, , Teutonico F, , Elliott RE, , Moshel YA, , LaJoie J, & Miles D, : Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery? Clinical article . J Neurosurg Pediatr 7:421430, 2011

    • Search Google Scholar
    • Export Citation
  • 9

    Chang EF, , Wang DD, , Barkovich AJ, , Tihan T, , Auguste KI, & Sullivan JE, : Predictors of seizure freedom after surgery for malformations of cortical development. Ann Neurol 70:151162, 2011

    • Search Google Scholar
    • Export Citation
  • 10

    de Oliveira RS, , Santos MV, , Terra VC, , Sakamoto AC, & Machado HR: Tailored resections for intractable rolandic cortex epilepsy in children: a single-center experience with 48 consecutive cases. Childs Nerv Syst 27:779785, 2011

    • Search Google Scholar
    • Export Citation
  • 11

    Elliott I, , Kadis DS, , Lach L, , Olds J, , McCleary L, & Whiting S, : Quality of life in young adults who underwent resective surgery for epilepsy in childhood. Epilepsia 53:15771586, 2012

    • Search Google Scholar
    • Export Citation
  • 12

    Engel J Jr, , Van Ness PC, , Rasmussen TB, & Ojemann LM, Outcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed 2 New York, Raven Press, 1993. 609621

    • Search Google Scholar
    • Export Citation
  • 13

    Englot DJ, , Han SJ, , Berger MS, , Barbaro NM, & Chang EF: Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors. Neurosurgery 70:921928, 2012

    • Search Google Scholar
    • Export Citation
  • 14

    Englot DJ, , Lee AT, , Tsai C, , Halabi C, , Barbaro NM, & Auguste KI, : Seizure types and frequency in patients who “fail” temporal lobectomy for intractable epilepsy. Neurosurgery 73:838844, 2013

    • Search Google Scholar
    • Export Citation
  • 15

    Englot DJ, , Rolston JD, , Wang DD, , Sun PP, , Chang EF, & Auguste KI: Seizure outcomes after temporal lobectomy in pediatric patients. A systematic review. J Neurosurg Pediatr 12:134141, 2013

    • Search Google Scholar
    • Export Citation
  • 16

    Englot DJ, , Wang DD, , Rolston JD, , Shih TT, & Chang EF: Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis. Clinical article. J Neurosurg 116:10421048, 2012

    • Search Google Scholar
    • Export Citation
  • 17

    Fallah A, , Guyatt GH, , Snead OC III, , Ebrahim S, , Ibrahim GM, & Mansouri A, : Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis. PLoS ONE 8:e53565, 2013

    • Search Google Scholar
    • Export Citation
  • 18

    Fish DR, & Spencer SS: Clinical correlations: MRI and EEG. Magn Reson Imaging 13:11131117, 1995

  • 19

    Fountas KN, , Smith JR, , Robinson JS, , Tamburrini G, , Pietrini D, & Di Rocco C: Anatomical hemispherectomy. Childs Nerv Syst 22:982991, 2006

    • Search Google Scholar
    • Export Citation
  • 20

    Gelinas JN, , Battison AW, , Smith S, , Connolly MB, & Steinbok P: Electrocorticography and seizure outcomes in children with lesional epilepsy. Childs Nerv Syst 27:381390, 2011

    • Search Google Scholar
    • Export Citation
  • 21

    Giulioni M, , Rubboli G, , Marucci G, , Martinoni M, , Volpi L, & Michelucci R, : Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection. Clinical article. J Neurosurg 111:12751282, 2009

    • Search Google Scholar
    • Export Citation
  • 22

    Hauptman JS, , Pedram K, , Sison CA, , Sankar R, , Salamon N, & Vinters HV, : Pediatric epilepsy surgery: long-term 5-year seizure remission and medication use. Neurosurgery 71:985993, 2012

    • Search Google Scholar
    • Export Citation
  • 23

    Hemb M, , Velasco TR, , Parnes MS, , Wu JY, , Lerner JT, & Matsumoto JH, : Improved outcomes in pediatric epilepsy surgery: the UCLA experience, 1986-2008. Neurology 74:17681775, 2010

    • Search Google Scholar
    • Export Citation
  • 24

    Jansen FE, , van Huffelen AC, , Algra A, & van Nieuwenhuizen O: Epilepsy surgery in tuberous sclerosis: a systematic review. Epilepsia 48:14771484, 2007

    • Search Google Scholar
    • Export Citation
  • 25

    Kassiri J, , Pugh J, , Carline S, , Jurasek L, , Snyder T, & Wheatley M, : Depth electrodes in pediatric epilepsy surgery. Can J Neurol Sci 40:4855, 2013

    • Search Google Scholar
    • Export Citation
  • 26

    Keene DL, , Loy-English I, & Ventureyra EC: Long-term socioeconomic outcome following surgical intervention in the treatment of refractory epilepsy in childhood and adolescence. Childs Nerv Syst 14:362365, 1998

    • Search Google Scholar
    • Export Citation
  • 27

    Kim H, , Lee C, , Knowlton R, , Rozzelle C, & Blount JP: Safety and utility of supplemental depth electrodes for localizing the ictal onset zone in pediatric neocortical epilepsy. Clinical article. J Neurosurg Pediatr 8:4956, 2011

    • Search Google Scholar
    • Export Citation
  • 28

    Knake S, , Triantafyllou C, , Wald LL, , Wiggins G, , Kirk GP, & Larsson PG, : 3T phased array MRI improves the presurgical evaluation in focal epilepsies: a prospective study. Neurology 65:10261031, 2005

    • Search Google Scholar
    • Export Citation
  • 29

    Larysz D, , Larysz P, & Mandera M: Evaluation of quality of life and clinical status of children operated on for intractable epilepsy. Childs Nerv Syst 23:9197, 2007

    • Search Google Scholar
    • Export Citation
  • 30

    Liang S, , Wang S, , Zhang J, , Ding C, , Zhang Z, & Fu X, : Longterm outcomes of epilepsy surgery in school-aged children with partial epilepsy. Pediatr Neurol 47:284290, 2012

    • Search Google Scholar
    • Export Citation
  • 31

    Liu S, , An N, , Yang H, , Yang M, , Hou Z, & Liu L, : Pediatric intractable epilepsy syndromes: reason for early surgical intervention. Brain Dev 29:6978, 2007

    • Search Google Scholar
    • Export Citation
  • 32

    Mani J, , Gupta A, , Mascha E, , Lachhwani D, , Prakash K, & Bingaman W, : Postoperative seizures after extratemporal resections and hemispherectomy in pediatric epilepsy. Neurology 66:10381043, 2006

    • Search Google Scholar
    • Export Citation
  • 33

    Mikati MA, , Ataya N, , Ferzli J, , Kurdi R, , El-Banna D, & Rahi A, : Quality of life after surgery for intractable partial epilepsy in children: a cohort study with controls. Epilepsy Res 90:207213, 2010

    • Search Google Scholar
    • Export Citation
  • 34

    Mikati MA, , Rahi AC, , Shamseddine A, , Mroueh S, , Shoeib H, & Comair Y: Marked benefits in physical activity and well-being, but not in functioning domains, 2 years after successful epilepsy surgery in children. Epilepsy Behav 12:145149, 2008

    • Search Google Scholar
    • Export Citation
  • 35

    Mittal S, , Montes JL, , Farmer JP, , Rosenblatt B, , Dubeau F, & Andermann F, : Long-term outcome after surgical treatment of temporal lobe epilepsy in children. J Neurosurg 103:5 Suppl 401412, 2005

    • Search Google Scholar
    • Export Citation
  • 36

    Moosa AN, , Gupta A, , Jehi L, , Marashly A, , Cosmo G, & Lachhwani D, : Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children. Neurology 80:253260, 2013

    • Search Google Scholar
    • Export Citation
  • 37

    Ogiwara H, , Nordli DR, , DiPatri AJ, , Alden TD, , Bowman RM, & Tomita T: Pediatric epileptogenic gangliogliomas: seizure outcome and surgical results. Clinical article. J Neurosurg Pediatr 5:271276, 2010

    • Search Google Scholar
    • Export Citation
  • 38

    Phi JH, , Cho BK, , Wang KC, , Lee JY, , Hwang YS, & Kim KJ, : Longitudinal analyses of the surgical outcomes of pediatric epilepsy patients with focal cortical dysplasia. Clinical article. J Neurosurg Pediatr 6:4956, 2010

    • Search Google Scholar
    • Export Citation
  • 39

    Ramantani G, , Strobl K, , Stathi A, , Brandt A, , Schubert-Bast S, & Wiegand G, : Reoperation for refractory epilepsy in childhood: a second chance for selected patients. Neurosurgery 73:695704, 2013

    • Search Google Scholar
    • Export Citation
  • 40

    Romanelli P, , Weiner HL, , Najjar S, & Devinsky O: Bilateral resective epilepsy surgery in a child with tuberous sclerosis: case report. Neurosurgery 49:732735, 2001

    • Search Google Scholar
    • Export Citation
  • 41

    Souza-Oliveira C, , Escorsi-Rosset S, , Terra VC, , Muxfeldt-Bianchin M, , Machado HR, & Sakamoto AC: Impact of pediatric epilepsy surgery on intellectual efficiency. Rev Neurol 54:214220, 2012

    • Search Google Scholar
    • Export Citation
  • 42

    Spencer S, & Huh L: Outcomes of epilepsy surgery in adults and children. Lancet Neurol 7:525537, 2008

  • 43

    Tripathi M, , Garg A, , Gaikwad S, , Bal CS, , Chitra S, & Prasad K, : Intra-operative electrocorticography in lesional epilepsy. Epilepsy Res 89:133141, 2010

    • Search Google Scholar
    • Export Citation
  • 44

    Westmoreland B, The electroencephalogram in tuberous sclerosis. Rodriguez-Gomez M, , Sampson JR, & Whittemore VH: Tubrous Sclerosis Complex: Developmental Perspectives in Psychiatry ed 3 New York, Oxford University Press, 1999. 6374

    • Search Google Scholar
    • Export Citation
  • 45

    Wray CD, , McDaniel SS, , Saneto RP, , Novotny EJ Jr, & Ojemann JG: Is postresective intraoperative electrocorticography predictive of seizure outcomes in children? Clinical article. J Neurosurg Pediatr 9:546551, 2012

    • Search Google Scholar
    • Export Citation
  • 46

    Wu JY, , Sankar R, , Lerner JT, , Matsumoto JH, , Vinters HV, & Mathern GW: Removing interictal fast ripples on electrocorticography linked with seizure freedom in children. Neurology 75:16861694, 2010

    • Search Google Scholar
    • Export Citation
  • 47

    Yun CH, , Lee SK, , Lee SY, , Kim KK, , Jeong SW, & Chung CK: Prognostic factors in neocortical epilepsy surgery: multivariate analysis. Epilepsia 47:574579, 2006

    • Search Google Scholar
    • Export Citation
  • 48

    Zaveri HP, , Pincus SM, , Goncharova II, , Duckrow RB, , Spencer DD, & Spencer SS: Localization-related epilepsy exhibits significant connectivity away from the seizure-onset area. Neuroreport 20:891895, 2009

    • Search Google Scholar
    • Export Citation

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