Multifocal resection in therapy of pediatric progredient epilepsy
https://doi.org/10.17749/2077-8333/epi.par.con.2020.031
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
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
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
Russian Federation
Aleksandr S. Shershever - MD, Dr Sci Med, Professor of the Department of Nervous Diseases.
29 Soboleva Str., Ekaterinburg 620036
References
1. Karlov V.A. Epilepsy in children and adults females and males. Physicians’ manual. 2/e. Moscow. 2019;. 896 s. (In Russ.).
2. Karlov V.A., Gecht A.B., Guzeva V.I. et al. Algorithms of mono- and polytherapy in clinical epiletology. Part 1. General principles of drug choice. Zhurnalnevrologiiipsihiatriiim. C.C. Korsakova. 2016; 116 (6): 109-114. (In Russ.). https://doi.org/10.17116/jnevro201611661109-114.
3. Zemskaya A.G., Ryabukha N.P., Garmashov Y.A. Tactics and results of surgical treatment of multifocal epilepsy. Zhurnal voprosy neurochirurgiiim. N.N. Burdenko. 1990; 1: 15-17. (In Russ.).
4. Ryabukha N.P., Bersnev V.P. Multifocal epilepsy (etiopathogenesis, clinics, diagnosing and surgical treatment). St.Petersburg. 2009 216 s. (In Russ.).
5. Mamatkhanov M.R., Kasumov V.R., Kuralbaev A.K. Surgical treatment of epilepsy and its results. Vestniknovykh meditsinskikh tekhnologiy. 2017; 24 (2): 44-53. (In Russ.). https://doi.org/10.12737/article_5947cd56962196.53541882.
6. Khachatryan W.A. Some actual problems in epilepsy treatment. Neurochirurgia inevrologia detskogo vozrasta. 2016; 4 (50): 8-15. (In Russ).
7. Hemb M., Velasco T.R., Parnes M.S. et al. Improved outcomes in pediatric epilepsy surgery: the UCLA experience, 1986-2008. Neurology. 2010; 74: 1768-1775. https://doi.org/10.1212/WNL.0b013e3181e0f17a.
8. Sarkis R.A., Jehi L., Najm I.M. et al. Seizure outcomes following multilobar epilepsy surgery. Epilepsia. 2012; 53: 44-50.
9. Kogias E., Schmeiser B., Doostkam S. et al. Multilobar Resections for 3T MRI-Negative Epilepsy: Worth the Trouble? World Neurosurgery. 2018; 123: 38-347. https://doi.org/10.1016/j.wneu.2018.11.170.
10. Hosoyama H., Matsuda K., Mihara T. et al. Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey. J Neurosurg Pediatr. 2017; 19 (5): 606-615. https://doi.org/10.3171/2016.12.PEDS16197.
11. Nilsson D.T., Malmgren K., Fink R., Rydenhag B. Outcomes of multilobar resections for epilepsy in Sweden 1990-2013: a national population-based study. Acta Neurochir (Wien). 2016; 158 (6): 1151-7. https://doi.org/10.1007/s00701-016-2807-3.
12. Isler C., Ozkara C., Kucukyuruk B., et al. Seizure outcome of patients with magnetic resonance imaging-negative epilepsies: still an ongoing debate. World Neurosurg. 2017; 106: 638-644. https://doi.org/10.1016/j.wneu.2017.07.046.
13. Barba C., Rheims S., Minotti L. et. al. Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain. 2016; 139 (2): 444-51. https://doi.org/10.1093/brain/awv372.
14. Jehi L., Sarkis R., Bingaman W. et al. When is a postoperative seizure equivalent to ‘‘epilepsy recurrence” after epilepsy surgery? Epilepsia. 2010; 51: 994-1003.
15. Cho E.B., Joo E.Y., Seo D-W,. Hong S.-C., Hong S.B. Prognostic role of functional neuroimaging after multilobar resection in patients with localizationrelated epilepsy. PLoS One. 2015; 10: e0136565.
16. Krsek P., Jahodova A., Maton B. et al. Low-grade focal cortical dysplasia is associated with prenatal and perinatal brain injury. Epilepsia. 2010; 51: 2440-2448.
17. Ramantani G., Strobl K., Stathi A. et al. Reoperation for refractory epilepsy in childhood: a second chance for selected patients. Neurosurgery. 2013;73: 695-704.
18. Ramantani G., Kadish N.E., Mayer H. et al. Frontal lobe epilepsy surgery in childhood and adolescence: predictors of long-term seizure freedom, overall cognitive and adaptive functioning. Neurosurgery. 2018;83:93-103.
19. Binder D.K., Von Lehe M, Kral T. et al. Surgical treatment of occipital lobe epilepsy. J Neurosurg. 2008; 109: 57-69. https://doi.org/10.3171/JNS/2008/109/7/0057.
20. Jacobs J., Dubeau F., Olivier A., Andermann F. Pathways of seizure propagation from the temporal to the occipital lobe. Epileptic Disord. 2008; 10: 266-270. https://doi.org/10.1684/epd.2008.0217.
21. Jenssen S., Roberts C.M., Gracely E.J. et al. Focal seizure propagation in the intracranial EEG. Epilepsy Res. 2011; 93: 25-32.
22. Koubeissi M.Z., Jouny C.C., Blakeley J.O., Bergey G.K. Analysis of dynamics and propagation of parietal cingulate seizures with secondary mesial temporal involvement. Epilepsy Behav. 2009; 14: 108-112.
23. Isnard J., Guenot M., Sindou M., Mauguiere F. Clinical manifestations of insular lobe seizures: a stereo-electroencephalographic study. Epilepsia. 2004; 45: 1079-1090. https://doi.org/10.1111/j.0013-9580.2004.68903.x.
24. Levitt M.R., Ojemann J.G., Kuratani J. Insular epilepsy masquerading as multifocal cortical epilepsy as proven by depth electrode. J Neurosurg Pediatr. 2010;5:365-367.
Review
For citations:
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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