Seizure outcomes after resective surgery for extra–temporal lobe epilepsy in pediatric patients

A systematic review

Dario J. EnglotDepartment of Neurological Surgery, University of California, San Francisco; and

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Jonathan D. BreshearsDepartment of Neurological Surgery, University of California, San Francisco; and

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Peter P. SunDepartment of Neurological Surgery, University of California, San Francisco; and
Division of Neurosurgery, Children's Hospital and Research Center Oakland, California

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Edward F. ChangDepartment of Neurological Surgery, University of California, San Francisco; and

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Kurtis I. AugusteDepartment of Neurological Surgery, University of California, San Francisco; and
Division of Neurosurgery, Children's Hospital and Research Center Oakland, California

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While temporal lobe epilepsy (TLE) is the most common epilepsy syndrome in adults, seizures in children are more often extratemporal in origin. Extra–temporal lobe epilepsy (ETLE) in pediatric patients is often medically refractory, leading to significantly diminished quality of life. Seizure outcomes after resective surgery for pediatric ETLE vary tremendously in the literature, given diverse patient and epilepsy characteristics and small sample sizes. The authors performed a systematic review and meta-analysis of studies including 10 or more pediatric patients (age ≤ 19 years) published over the last 20 years examining seizure outcomes after resective surgery for ETLE, excluding hemispherectomy. Thirty-six studies were examined. These 36 studies included 1259 pediatric patients who underwent resective surgery for ETLE. Seizure freedom (Engel Class I outcome) was achieved in 704 (56%) of these 1259 patients postoperatively, and 555 patients (44%) continued to have seizures (Engel Class II–IV outcome). Shorter epilepsy duration (≤ 7 years, the median value in this study) was more predictive of seizure freedom than longer (> 7 years) seizure history (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.07–2.14), suggesting that earlier intervention may be beneficial. Also, lesional epilepsy was associated with better seizure outcomes than nonlesional epilepsy (OR 1.34, 95% CI 1.19–1.49). Other predictors of seizure freedom included an absence of generalized seizures (OR 1.61, 95% CI 1.18–2.35) and localizing ictal electroencephalographic findings (OR 1.55, 95% CI 1.24–1.93). In conclusion, seizure outcomes after resective surgery for pediatric ETLE are less favorable than those associated with temporal lobectomy, but seizure freedom may be more common with earlier intervention and lesional epilepsy etiology. Children with continued debilitating seizures despite failure of multiple medication trials should be referred to a comprehensive pediatric epilepsy center for further medical and surgical evaluation.

Abbreviations used in this paper:

AED = antiepileptic drug; CI = confidence interval; ECoG = electrocorticography; EEG = electroencephalography; ETLE = extra–temporal lobe epilepsy; OR = odds ratio; TLE = temporal lobe epilepsy.
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