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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
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. AsatryanArmenia
Asatryan Eduard Artushevich – MD, neurosurgeon at the Department of Pediatric.
46a, Artashesyan str, Yerevan, 0039
K. B. Abramov
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
Russian Federation
Mamatkhanov Magomed Ramazanovich – MD, neurosurgeon, senior researcher at the Department of Pediatric Neurosurgery.
12 Mayakovskogo st., St. Petersburg, 191014
K. E. Lebedev
Russian Federation
Lebedev Konstantin Eduardovich – MD, neurologist, senior researcher at the Department of Pediatric Neurosurgery.
12 Mayakovskogo st., St. Petersburg, 191014
A. Y. Efimtsev
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
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
Russian Federation
Sebelev Konstantin Ivanovich – MD, PhD, head of the Radiology Department with angiographic complex.
12 Mayakovskogo st., St. Petersburg, 191014
D. V. Ryzhkova
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
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
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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Supplementary files
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 paroxyzmal conditions. 2017;9(1):40-50. https://doi.org/10.17749/2077-8333.2017.9.1.040-050
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