Resective epilepsy surgery is a viable option to help improve both seizure control and adaptive functioning in patients with Lennox-Gastaut syndrome, according to an article published in Pediatrics.
To evaluate the long-term outcomes for patients with Lennox-Gastaut syndrome who had undergone resective epilepsy surgery, researchers reviewed 90 patient case reports for surgeries performed at the Severance Children’s Hospital from 2003 to 2014 and managed them for at least 2 years following. Patients were between 3 and 23.5 years old at the time of surgery (mean±SD: 9.3±4.4) with 0.7 to 20.1 years from the time of first seizure to surgery (7.2±4.3). The most common pathologic finding was malformation of cortical development, which was noted in 62.3% (n=57) of patients.
Better social competence and adaptive behavior was achieved by seizure-free patients at post-surgery follow-ups compared with patients with persistent seizures
The study investigators concluded that “[c]areful preoperative investigations can be used to steer the course of LGS in patients toward seizure-free status and better outcomes in adaptive functioning and social competence. Resective surgery should be actively used to treat patients with LGS with suspected focal epileptic pathology.”
Kang JW, Eom S, Hong W, et al. Long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome [published online September 7, 2018]. Pediatrics. doi: 10.1542/peds.2018-0449
There is significant variation in the use of diagnostic testing and resective strategies among major epilepsy surgery centers practicing surgical resection in epileptogenic zones (EZ) in close proximity to or in the eloquent cortex (EC), according to results of a survey administered on behalf of the International League Against Epilepsy and published in Epilepsia.
Of the 40 survey respondents, 19 were from North America, 13 were from Europe, 3 were from Australia, 3 were from South America, and 2 were from Asia. Ultimately, 24 neurologists and 16 neurosurgeons responded. The survey comprised a total of 38 question categories that included 84 individual queries on the EZ, EC, plasticity, and resection strategies. The survey was designed to evaluate the weight assigned to diagnostic tests that are used to define the EZ and EC, how EC is viewed, and how surgeries are scheduled for foci that are near or in the EC. Respondents were required to assign weights of 1 to 5 to various diagnostic test findings.
A descriptive analysis revealed considerable variation in the use of diagnostic tests and resective strategies toward the EZ and the EC. This widespread variation in strategies may contribute to undesirable outcomes that are characterized by poor seizure control and added deficits.
The results of this survey underscore the need to establish best practices in pediatric epilepsy surgery. The data derived from this survey were used to devise a set of recommendations that will help minimize deficits and make certain that such deficits are reported consistently. Development of a scale that can be used to report deficits has also been proposed.
Jayakar P, Jayakar A, Libenson M, et al; Pediatric Epilepsy Surgery Task Force; International League Against Epilepsy. Epilepsy surgery near or in eloquent cortex in children-practice patterns and recommendations for minimizing and reporting deficits. Epilepsia. 2018;59:1484-1491.
Source: Article by S. Jacobs for Neurology Advisor
Little has been known about the long-term success of epilepsy surgery, even though surgeons have performed the surgery for decades. In a recent study, researchers sought to determine whether epilepsy surgery would provide long-term improvements.
Epilepsy affects the brain and causes seizures, which can occur in many different ways. Seizures can range from a few seconds of being confused to a complete lack of awareness of what is going on. People who suffer from epilepsy can be treated with medicine; however, in approximately 30% of people, the medicine does not stop the seizures. Individuals with epilepsy tend to have epilepsy surgery as relatively young adults in hopes of many years of a better quality of life ahead of them.
Epilepsy surgery adds several years to the life expectancy of children with refractory epilepsy who are deemed suitable surgical candidates, and it may improve their quality of life compared with continuing medical therapy only, a new study suggests.
While there’s a growing consensus that surgery is sometimes an optimal choice in some pediatric patients, the new research actually quantifies the benefits, said lead researcher, Iván Sánchez Fernández, MD, an epilepsy fellow in the Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Massachusetts.
“Our model quantifies how this translates in terms of life expectancy, and the quantification shows that epilepsy surgery provides, in general, approximately 5 years of extra life expectancy when compared to medical management only.”
Unfortunately, many children who are surgical candidates still continue to be maintained for years on medical treatment only, he said.
The research was presented here at the 43rd Annual Child Neurology Society Meeting.
To compare surgical intervention with continued medical therapy only, researchers collected published articles that evaluated the different factors that contribute to life expectancy in the pediatric refractory epilepsy population. They then developed a decision analysis model that considers all factors contributing to life expectancy.
“This includes mortality in the general population, mortality in seizure-free patients, mortality in patients with refractory epilepsy, perioperative mortality, and perioperative complications, among other factors,” said Dr Sánchez Fernández.
They found that epilepsy surgery yielded a higher life expectancy than only medical treatment. For a cohort of 10-year-old children with refractory epilepsy, the gain in life expectancy with surgery was 5.9 years for temporal lobe epilepsy and 5.6 years for extratemporal epilepsy.
A sensitivity analysis showed that medical management only would be the preferred strategy only under very particular circumstances in which several factors are highly skewed against surgery: for example, very high perioperative risks and low probability of becoming seizure free with surgery.
Dr Sánchez Fernández stressed that the study was based on information already available in the literature. “We have not collected new data for this model.”
Quality of Life
The researchers didn’t attempt to quantify quality of life in children with epilepsy who had surgery or are maintained on medical treatment. As Dr Sánchez Fernández explained, this would require the estimation of utilities, a measure of how much a person values his or her life in their present state compared to a state of perfect health. Utility measures, he said, are frequently used in decision analyses.
However, the researchers did something similar; they estimated the proportion of life expectancy spent in seizure freedom. For a cohort of 10-year-old patients with refractory temporal epilepsy, surgery yielded 48.9% of life expectancy years in seizure freedom while medical treatment yielded 14.3%.
For those with extratemporal epilepsy, surgery yielded 43.0% of life expectancy years in seizure freedom vs 14.3% with medical treatment.
KEEP READING AT SOURCE: http://www.medscape.com/viewarticle/833767?src=rss
A Knoxville man is trying to convince his little sister to have a surgery that could change her life. We introduced you to Brittany Ball earlier this year. She has a severe form of epilepsy that causes multiple seizures each day, despite her medication.
Brittany has always been close to her older brother Jason Branam.
“I want her to have a normal life. I want her to see more of her friends. I want her to be able to hang out like I got to,” Jason said.
Brittany’s epilepsy is hard to control and her seizures are hard to predict.
“It’s just a roller coaster of medicine,” she said.
Her brother and mother want her to try another option – brain surgery.
“There’s a lot of risk. It’s very dangerous,” said Donna Ball.
That’s why Brittany has always been against it.
“I could be a vegetable. I could lose my speech. I could lose my hearing,” she said.
Her father sides with Brittany.
“It is just extremely scary,” said Dennis Ball.
Her brother asked recently if getting a million likes on Facebook would change Brittany’s mind.
Then he took it a step further, creating the page “Support for Brittany Ball.” Within just 20 minutes, it had 100 likes.
“I just started crying. I didn’t believe I would have this many people backing me up,” Brittany said.
Even if the surgery went smoothly, there’s only a 50/50 chance it would stop or significantly reduce her seizures. Still the Facebook page, with nearly 2,500 likes now, combined with a recent church service, have her seriously considering it for the first time.
“It motivates me more to have the surgery, think about it, research it,” Brittany said.
Her brother Jason says that’s a step in the right direction.
“I feel like if she sees a million people like the page, she’s not going to want to let them down. She’s actually going to go through with it,” he said.
If Brittany decides she wants to try brain surgery, she’ll have to go through extensive testing to make sure she’s actually a candidate. That’s when her brother says he’ll start fundraising. The family isn’t sure insurance will pay for the risky surgery.