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.
A specialized test for epilepsy patients is allowing doctors to better plan for epilepsy surgery, while avoiding catastrophic effects on speech and memory.
“It involves using an anesthetic called etomidate to put one half of the brain to sleep at a time while testing the language and memory abilities in the opposite hemisphere,” explains neuropsychologist Antonina Omisade.
Omisade says there are two main goals to the etomidate speech and memory test – or ESAM for short.
Drug-resistant children and adolescents that undergo epilepsy surgery have a significantly higher rate of seizure-free periods and better quality of life compared to those who simply continue medical therapy, according to a new study published in the New England Journal of Medicine. Manjari Tripathi, MD, DM
Researchers led by Manjari Tripathi, MD, DM, professor of neurology at the All India Institute of Medical Sciences in New Delhi, examined how neurosurgical treatment affected seizure rates in 116 children and adolescents with epilepsy. In total, 77% (n = 44) of patients that received the surgery were free from seizures, compared to 7% (n = 4) in the medication group (P <.001).