Seizure outcomes after temporal lobectomy in pediatric patients

A systematic review

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

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John D. RolstonDepartment of Neurological Surgery, University of California, San Francisco; and

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Doris D. WangDepartment 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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Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults and is responsible for 15%–20% of epilepsy cases in children. Class I evidence strongly supports the use of temporal lobectomy for intractable TLE in adults, but fewer studies have examined seizure outcomes and predictors of seizure freedom after temporal lobectomy in pediatric patients. 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 temporal lobectomy for TLE. Thirty-six studies met their inclusion criteria. These 36 studies included 1318 pediatric patients with a mean age (± SEM) of 10.7 ± 0.3 years. Overall, seizure freedom (Engel Class I outcome) was achieved in 1002 cases (76%); 316 patients (24%) continued to have seizures (Engel Class II–IV outcome). All patients had at least 1 year of follow-up. Statistically significant predictors of seizure freedom after surgery included lesional epilepsy etiology (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02–1.15), abnormal findings on preoperative MRI (OR 1.27, 95% CI 1.16–1.40), and lack of generalized seizures (OR 1.36, 95% CI 1.20–1.56). Among lesional epilepsy cases, there was a trend toward better outcome with gross-total lesionectomy than with subtotal resection. Approximately three-fourths of pediatric patients with TLE attain seizure freedom after temporal lobectomy. Favorable outcomes may be predicted by lesional epilepsy etiology, abnormal MRI, and lack of generalized seizures. Pediatric patients with medically refractory TLE should be referred to a comprehensive pediatric epilepsy center for surgical evaluation.

Abbreviations used in this paper:

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