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Staged surgery for most complex cases of childhood epilepsy

Staged surgery for most complex cases of childhood epilepsy

Counting Hands from one to five, isolated over white backgroundA staged approach to epilepsy surgery-with invasive brain monitoring followed by surgery in a single hospital stay-is a safe and beneficial approach to treatment for complex cases of epilepsy in children, reports the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“Staged epilepsy surgery with invasive electrode monitoring is safe in children with poorly localized medically refractory epilepsy,” write Drs. Jonathan Roth and Howard Weiner of NYU Langone Medical Center, New York City, New York. Their 13-year review suggests that complication rates decrease further as surgeons gain experience with staged epilepsy surgery.

Staged Surgery for the Most Complex Cases of Childhood Epilepsy

From 1996 to 2009, the researchers performed staged surgery in 161 children with refractory epilepsy that could not be controlled with anti-seizure medications. The children averaged about seven years old. Most had “multifocal” epilepsy originating from more than one area of the brain, often related to a genetic condition called tuberous sclerosis complex.

In the staged approach, children underwent two or more surgical procedures for epilepsy during one hospital admission. The first step was invasive monitoring-surgery to place electrodes, which were used to map the “epileptogenic” areas of the brain from which seizure activity was originating.

Eighty percent of children subsequently underwent surgery to resect the epileptogenic brain areas. In a total of 200 hospitalizations, the children underwent nearly 500 surgical procedures for invasive monitoring, resection, and electrode removal. Dr. Roth and colleagues write, “Most children underwent only one admission, most of which included two or three surgeries.”

The current study focused on the safety of staged epilepsy surgery. Complications occurred at rates expected for children undergoing neurosurgical procedures. This included serious but less-common complications, such as neurologic abnormalities and central nervous system infections; as well as minor complications such as bone absorption or noninfectious fevers. Twenty-five children had complications requiring surgery.

Benefits of Staged Surgeries Outweigh the Risks

“Notably, surgical experience appeared to lower the complication rate,” Dr. Roth and coauthors write. Complications decreased from 30 percent during the first six years of the experience, to 15 percent in the last six years. Complication rates were similar in different subgroups of patients, including those with more surgeries or more hospital admissions.

Surgery is an important treatment option for epilepsy that does not respond to medications. However, in some complex cases, the epileptogenic area can’t be readily identified or seizures are originating from multiple sites.

The authors’ department has previously reported good outcomes with staged surgery for children with complex epilepsy, producing large reductions in seizures for most patients. However, this approach is still not widely used, perhaps reflecting concerns that it might lead to high complication rates.

The new analysis suggests that staged epilepsy surgery in children is “relatively safe,” with no higher than expected types and rates of complications. However, “When considering the risk-benefit profile in these children with severe epileptic disorders, we found that the benefits outweigh the risks,” Dr. Roth and colleagues write.

They believe the staged surgical approach is especially appropriate, given the high risks of severe and repeated seizures in complex childhood epilepsy. The researchers have no single explanation for the reduction in complications over their 13-year experience, but it may reflect close attention to key technical details and patient care routines.

Source: Wolters Kluwer Health

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6 Comments

  1. Been there with my son. He had tried nearly every anticonvulsant medication, and he was on the ketogenic diet. All of which Did nothing, matter of fact, his seizures became worse over time. He went in for brain mapping on a Tuesday and biopsy and partial resection on that Friday. He required a third surgery to do a complete removal of his left hippocampus and temporal lobe due to a ganglioglioma. Today he still has seizures, but mild in nature compared to before. He still takes numerous medications as well. We have found out that he has another brain tumor that is inoperable.

  2. Been there with my son. He had tried nearly every anticonvulsant medication, and he was on the ketogenic diet. All of which Did nothing, matter of fact, his seizures became worse over time. He went in for brain mapping on a Tuesday and biopsy and partial resection on that Friday. He required a third surgery to do a complete removal of his left hippocampus and temporal lobe due to a ganglioglioma. Today he still has seizures, but mild in nature compared to before. He still takes numerous medications as well. We have found out that he has another brain tumor that is inoperable.

  3. my son who passed away two yrs ago, did the best surg. in Seattle Washington, first to rid him of seizures, then after a TBI his 2nd surg.. Best hospital in the world.

  4. My 7 year old underwent a surgery after several medications did nothing to reduce the number of seizures she had every day. Now five months later, she is still seizure free, for the first time in 5 1/2 years. We are so thankful for every seizure free day!

  5. Carol Crumpler, I’m so Sorry for your loss. I know that Those words seem so ordinary, but I fear each day what it’d be like if I lost my son. I can not imagine your pain. I know that you Did all that you could do to give him quality of life. What is a TBI? I am slow in medical terms, Lol.
    My son is under medical care at CHILDREN’S HOSPITAL OF PHILADELPHIA. He had been to 4 different hospitals from Philly, Jersey and Delaware before we could get answers for Why he was having seizures and what the abnormality was on his brain. Three years after our journey begun, we found out through a battery of tests that it was more than likely a brain tumor. In the world of normalcy you feel like you stand alone because when your child has an event in public, the people just walk past you like your child is an alien. My son has fallen down out in the street and nobody would help me get him to safety.
    I am Sorry I rambled on about my son case, I just can’t help it sometimes. It is sometimes an uncontrollable habit. I hope you find peace within your loss somehow. It’s great that you stay connected to people that can understand and/or relate. I pray for your peace and happiness

  6. Traumatic Brain Injury… I thought about it Carol Crumpler and It came to me.
    I’d love to listen to your story. Share with me if and when you’d like.

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