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Epilepsia and paroxysmal conditions

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DIAGNOSTICS AND LONG-TERM OUTCOMES AFTER SURGICAL TREATMENT OF EPILEPSY IN CHILDREN WITH STRUCTURAL BRAIN CHANGES

https://doi.org/10.17749/2077-8333.2017.9.1.040-050

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Abstract

Objective. To identify predictive factors of favourable outcomes in children with drug resistant epilepsy (DRE) associated with structural brain changes,  who received surgical treatment. 

Methods. We performed  a retrospective  analysis of surgical treatment in 239 children with drug resistant epilepsy treated at the Pediatric Neurosurgery Department of the A. L. Polenov Russian Neurosurgical Institute from 2004 to 2014. The age of the patients varied between  2 and 18 years. The follow-up time ranged from 1 year to 10 years (on average 4.3 years).

Results. According to magnetic resonance imaging (MRI), 223 (93.3%) patients had different structural brain changes. Among the patients, 47 (21.1%) had cerebral cicatrix, gliosis, cysts  and atrophic changes, 33 (14.8%) had malformations of the cortical development, 43 (19.3%) had benign brain tumors,  47 (21.1%)  had vascular malformations,  21 (9.4%)  had arachnoid cysts,  12 (5.4%)  had hippocampal sclerosis,  11  (4.9%)  had  phacomatosis, 5  (2.2%)  had  Rasmussen’s encephalitis,  and  4  (1.8%)  had  hypothalamic hamartoma.  Positron  emission  tomography  revealed the  areas of gray matter  hypometabolism in the  brain, which correspond to the areas of a metabolic deficiency around the epileptic focus. Favorable long-term outcomes of epilepsy surgery (class I according to Engel scale) were registered in 67.6% of the cases.  The most  favorable results (class I according to Engel scale) were achieved after lesionectomy (81.9%), temporal resections (78.4%), and hemispherectomy (72.7%).

Conclusions. The most important predictive factors of favorable outcomes after epilepsy surgery are as follows: detection of epileptogenic morphological changes of the brain, completeness of resection of an epileptic and epileptogenic areas, and absense  of seizures in the early postoperative period.

About the Authors

E. A. Asatryan
Medical Center “Sourb Astvatsamayr”
Armenia

Asatryan Eduard Artushevich  – MD, neurosurgeon at the Department  of Pediatric.

46a, Artashesyan str, Yerevan, 0039



K. B. Abramov
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Abramov  Konstantin  Borisovich  –  meurosurgeon  at  the  Department  of  Pediatric  Neurosurgery.

12 Mayakovskogo st., St. Petersburg, 191014, Tel. +7(812)273-80-96, fax 8(812)273-81-96



M. R. Mamatkhanov
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Mamatkhanov Magomed Ramazanovich – MD, neurosurgeon, senior researcher at the Department of Pediatric Neurosurgery.

12 Mayakovskogo st., St. Petersburg, 191014



K. E. Lebedev
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Lebedev  Konstantin  Eduardovich  –  MD, neurologist,  senior  researcher  at  the  Department  of  Pediatric  Neurosurgery.

12 Mayakovskogo st., St. Petersburg, 191014



A. Y. Efimtsev
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Efimtsev Aleksandr  Yur’evich  – MD, head  of the scientific research  laboratory  of radiation  imaging, associate  professor at the Department of Radiology and Medical imaging, V. A. Almazov  FN-WMRC.

2  Akkuratova  st.,  St.  Petersburg, 197341



Yu. M. Zabrodskaya
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Zabrodskaya Yuliya Mikhailovna – MD, PhD, pathologist, head of the scientific research  laboratory of anatomical pathology, A. L. Polenov RNRI, the branch of the V. A. Almazov FN-WMRC.

12 Mayakovskogo st., St. Petersburg, 191014



K. I. Sebelev
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Sebelev Konstantin Ivanovich – MD, PhD, head of the Radiology Department with angiographic complex.

12 Mayakovskogo st., St. Petersburg, 191014



D. V. Ryzhkova
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Ryzhkova Dar’ya Viktorovna – MD, PhD, head of Scientific and Clinical Association of Nuclear Medicine and PET center, head of scientific research laboratory of nuclear medicine, professor at the Department of Radiology and Medical Imaging, V. A. Almazov  FN-WMRC.

2 Akkuratova st., St. Petersburg, 197341



G. E. Trufanov
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Trufanov Gennadii Evgen’evich  –  MD, PhD,  head  of  the  Research  Department  of  Radiology,  head  of  the  Department of Radiology and Medical Imaging, V. A. Almazov  FN-WMRC.

2 Akkuratova st., St. Petersburg, 197341



W. А. Khachatryan
A. L. Polenov Russian Neurosurgical Institute – a branch of V. A. Almazov North-Western Federal Medical Research Center
Russian Federation

Khachatryan Willilam Aramovich – MD, PhD, Professor, honored  scientist  of Russia, head of the Department  of Pediatric neurosurgery.

12 Mayakovskogo st., St. Petersburg, 191014



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For citation:


Asatryan E.A., Abramov K.B., Mamatkhanov M.R., Lebedev K.E., Efimtsev A.Y., Zabrodskaya Y.M., Sebelev K.I., Ryzhkova D.V., Trufanov G.E., Khachatryan W.А. DIAGNOSTICS AND LONG-TERM OUTCOMES AFTER SURGICAL TREATMENT OF EPILEPSY IN CHILDREN WITH STRUCTURAL BRAIN CHANGES. Epilepsia and paroxysmal conditions. 2017;9(1):40-50. (In Russ.) https://doi.org/10.17749/2077-8333.2017.9.1.040-050

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ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)