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Epilepsy and paroxysmal conditions

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Multifocal resection in therapy of pediatric progredient epilepsy

https://doi.org/10.17749/2077-8333/epi.par.con.2020.031

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Abstract

Objective. To analyze the long-term results after surgical treatment of multifocal cortical epilepsy in children and determine prognostic factors. The use of multilobar resections in the surgical treatment of pediatric multi-focal epilepsy remains an pressing problem of current neurology and neurosurgery.

Materials and methods. A retrospective analysis of the multifocal resections data in 47 children with drug-resistant single-hemispheric multifocal epilepsy was performed by monitoring patients between age of 8 months up to 17 years old, who were operated from 1994 to 2014, additionally examined for prognostic factors affecting short- and long-term treatment outcomes after surgery.

Results. According to the MRI data, structural changes in the brain were found in 63.8% subjects, whereas in 36.2% cases no pathology was detected. The following types of surgical interventions were performed: fronto-temporal resection - 44.68% cases; temporal resection combined with subpial removal of the frontal and parietal cortex in 21.28% patients; resection of the temporal lobe and cortical foci of the parietal lobe - 19.15%; removal of the temporal, parietal and occipital lobes - 2 cases; resection of the temporal and occipital - 2 cases; resection of the temporal lobe in combination with multifocal resection of the cortical epileptic foci of the frontal, parietal and occipital lobes - 1 cases; fronto-central-parietal combined with multiple subpial transection of the cortex - 1 case, fronto-parieto-occipital - 1 case. Immediately in postoperative period and up to 12 months post-surgery, seizures disappeared in 42.9% cases, whereas in long-term period results remained stable with Engel I outcome in 41.7% after 3 years, 41.2% - after 5 years and 40.6% - after 10 years post-surgery.

Conclusion: Multilobar resections performed in multifocal epilepsy allow to provide a favorable result in the short-term and long-term period with fully abrogated seizures in 48% and 41% cases, respectively. Positive prognostic factors were found to be duration of epilepsy less than 7 years, onset of the disease at school age, lack of generalized seizures and epileptic status in history, as well as the vastness of surgery.

About the Authors

V. A. Khachatryan
Almazov National Medical Research Center
Russian Federation

William A. Khachatryan - MD, Dr Sci Med, Professor, Head of the Department of Pediatric Neurosurgery, Scopus ID: 55633841500; Researcher ID: G-4002-2018.

2 Akkuratova Str., St Petersburg 197341




M. R. Mamatkhanov
Almazov National Medical Research Center
Russian Federation

Magomed R. Mamatkhanov - MD, PhD, Senior Researcher, Department of Pediatric Neurosurgery, Research Laboratory of Neurosurgery.

2 Akkuratova Str., St Petersburg 197341




A. S. Shershever
Sverdlovsk Regional Oncology Center
Russian Federation

Aleksandr S. Shershever - MD, Dr Sci Med, Professor of the Department of Nervous Diseases.

29 Soboleva Str., Ekaterinburg 620036




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For citation:


Khachatryan V.A., Mamatkhanov M.R., Shershever A.S. Multifocal resection in therapy of pediatric progredient epilepsy. Epilepsy and paroxysmal conditions. 2020;12(3):147-157. (In Russ.) https://doi.org/10.17749/2077-8333/epi.par.con.2020.031

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