Alexander G. WeilDivision of Neurosurgery, Sainte-Justine University Hospital and University of Montreal Hospital Centre (CHUM), Montreal; Department of Neuroscience, University of Montreal; and Sainte-Justine Research Centre, University of Montreal, Quebec, Canada
The prevalence of long-term postoperative sensorimotor deficits in children undergoing perirolandic resective epilepsy surgery is unclear. The risk of developing these deficits must be weighed against the potential reduction in seizure frequency after surgery. In this study, the authors investigated the prevalence of sensorimotor deficits after resective surgery at ≥ 1 year postoperatively.
A systematic review and individual patient data meta-analysis was conducted using PubMed, Embase, and Scopus databases. Subgroups of patients were identified and categorized according to their outcomes as follows: group A patients were denoted as seizure free with no postoperative sensorimotor deficits; group B patients experienced seizure recurrence with no deficit; group C patients were seizure free with deficits; and group D patients were not seizure free and with deficits. Rates of sensory deficits were examined in patients undergoing postcentral gyrus resection, and rates of motor deficits were aggregated in patients undergoing precentral gyrus resection.
Of 797 articles resulting from the database searches, 6 articles including 164 pediatric patients at a mean age of 7.7 ± 5.2 years with resection for drug-resistant perirolandic epilepsy were included in the study. Seizure freedom was observed in 118 (72.9%) patients at a mean follow-up of 3.4 ± 1.8 years. In total, 109 (66.5%) patients did not develop sensorimotor deficits at last follow-up, while 55 (33.5%) had permanent deficits. Ten (14.3%) of 70 patients with postcentral gyrus resection had permanent sensory deficits. Of the postcentral gyrus resection patients, 41 (58.6%) patients were included in group A, 19 (27.1%) in group B, 7 (10.0%) in group C, and 3 (4.3%) in group D. Forty (37.7%) of 106 patients with precentral resections had permanent motor deficits. Of the precentral gyrus resection patients, 50 (47.2%) patients were in group A, 16 (15.1%) in group B, 24 (22.6%) in group C, and 16 (15.1%) in group D. Patients without focal cortical dysplasia were more likely to have permanent motor deficits relative to those with focal cortical dysplasia in the precentral surgery cohort (p = 0.02).
In total, 58.6% of patients were seizure free without deficit, 27.1% were not seizure free and without deficit, 10.0% were seizure free but with deficit, and 4.3% were not seizure free and with deficit. Future studies with functional and quality-of-life data, particularly for patients who experience seizure recurrence with no deficits (as in group B in the present study) and those who are seizure free with deficits (as in group C) after treatment, are necessary to guide surgical decision-making.
LawnND, BamletWR, RadhakrishnanK, O’BrienPC, SoEL. Injuries due to seizures in persons with epilepsy: a population-based study. Neurology. 2004;63(9):1565–1570.1553423710.1212/01.WNL.0000142991.14507.B5)| false
de OliveiraRS, SantosMV, TerraVC, SakamotoAC, MachadoHR. Tailored resections for intractable rolandic cortex epilepsy in children: a single-center experience with 48 consecutive cases. Childs Nerv Syst. 2011;27(5):779–785.
de OliveiraRS, SantosMV, TerraVC, SakamotoAC, MachadoHR. Tailored resections for intractable rolandic cortex epilepsy in children: a single-center experience with 48 consecutive cases. Childs Nerv Syst. 2011;27(5):779–785.2122221310.1007/s00381-010-1355-z)| false
GopinathS, RoyAG, VinayanKP, Seizure outcome following primary motor cortex-sparing resective surgery for perirolandic focal cortical dysplasia. Int J Surg. 2016;36(Pt B):466–476.2654298610.1016/j.ijsu.2015.10.036)| false
YanH, ToyotaE, AndersonM, A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood. J Neurosurg Pediatr. 2018;23(3):274–284.3054436410.3171/2018.9.PEDS18417)| false
ShlobinNA, MoherD. Commentary: Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement: what neurosurgeons should know. Neurosurgery. 2021;89(5):E267–E268.3435288810.1093/neuros/nyab289)| false
BehdadA, LimbrickDDJr, BertrandME, SmythMD. Epilepsy surgery in children with seizures arising from the rolandic cortex. Epilepsia. 2009;50(6):1450–1461.1905440110.1111/j.1528-1167.2008.01868.x)| false
BeniflaM, SalaFJr, JaneJJr, Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex Clinical article. J Neurosurg Pediatr. 2009;4(3):199–216.1977240310.3171/2009.3.PEDS08459)| false
ChenHH, ChenC, HungSC, et al.Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better. Childs Nerv Syst. 2014;30(11):1885–1895.
ChenHH, ChenC, HungSC, Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better. Childs Nerv Syst. 2014;30(11):1885–1895.2529655010.1007/s00381-014-2463-y)| false
TandonN, TongBA, FriedmanER, et al.Analysis of morbidity and outcomes associated with use of subdural grids vs stereoelectroencephalography in patients with intractable epilepsy. JAMA Neurol. 2019;76(6):672–681.
TandonN, TongBA, FriedmanER, Analysis of morbidity and outcomes associated with use of subdural grids vs stereoelectroencephalography in patients with intractable epilepsy. JAMA Neurol. 2019;76(6):672–681.3083014910.1001/jamaneurol.2019.0098)| false
JehiL, Morita-ShermanM, LoveTE, Comparative effectiveness of stereotactic electroencephalography versus subdural grids in epilepsy surgery. Ann Neurol. 2021;90(6):927–939.3459033710.1002/ana.26238)| false
SacinoMF, HuangSS, SchreiberJ, GaillardWD, OluigboCO. Is the use of stereotactic electroencephalography safe and effective in children? A meta-analysis of the use of stereotactic electroencephalography in comparison to subdural grids for invasive epilepsy monitoring in pediatric subjects. Neurosurgery. 2019;84(6):1190–1200.
SacinoMF, HuangSS, SchreiberJ, GaillardWD, OluigboCO. Is the use of stereotactic electroencephalography safe and effective in children? A meta-analysis of the use of stereotactic electroencephalography in comparison to subdural grids for invasive epilepsy monitoring in pediatric subjects. Neurosurgery. 2019;84(6):1190–1200.3035138210.1093/neuros/nyy466)| false
KatzJS, AbelTJ. Stereoelectroencephalography versus subdural electrodes for localization of the epileptogenic zone: what is the evidence?Neurotherapeutics. 2019;16(1):59–66.3065225310.1007/s13311-018-00703-2)| false
BjellviJ, CrossJH, GogouM, Classification of complications of epilepsy surgery and invasive diagnostic procedures: a proposed protocol and feasibility study. Epilepsia. 2021;62(11):2685–2696.3440589010.1111/epi.17040)| false
SeiamAHR, DhaliwalH, WiebeS. Determinants of quality of life after epilepsy surgery: systematic review and evidence summary. Epilepsy Behav. 2011;21(4):441–445.2169701510.1016/j.yebeh.2011.05.005)| false
ShlobinNA, ClarkJR, HoffmanSC, HopkinsBS, KesavabhotlaK, DahdalehNS. Patient education in neurosurgery: part 1 of a systematic review. World Neurosurg. 2021;147:202–214.e1.3330725510.1016/j.wneu.2020.11.168)| false
ShlobinNA, ClarkJR, HoffmanSC, HopkinsBS, KesavabhotlaK, DahdalehNS. Patient education in neurosurgery: part 2 of a systematic review. World Neurosurg. 2021;147:190–201.e1.3330726310.1016/j.wneu.2020.11.169)| false
YanH, IbrahimGM. Resective epilepsy surgery involving eloquent cortex in the age of responsive neurostimulation: a value-based decision-making framework. Epilepsy Behav. 2019;99:106479.3144276610.1016/j.yebeh.2019.106479)| false
BercuMM, FriedmanD, SilverbergA, Responsive neurostimulation for refractory epilepsy in the pediatric population: a single-center experience. Epilepsy Behav. 2020;112:107389.3289079610.1016/j.yebeh.2020.107389)| false
NagahamaY, ZervosTM, MurataKK, et al.Real-world preliminary experience with responsive neurostimulation in pediatric epilepsy: a multicenter retrospective observational study. Neurosurgery. 2021;89(6):997–1004.
ShlobinNA, CampbellJM, RosenowJM, RolstonJD. Ethical considerations in the surgical and neuromodulatory treatment of epilepsy. Epilepsy Behav. 2022;127:108524.3499826710.1016/j.yebeh.2021.108524)| false