Anti-epileptic drugs control seizures and improve quality of life for most people with epilepsy. But for those who find medical treatment ineffective or intolerable, brain surgery is sometimes the next best option. Two studies to be presented at the 68th AES Annual Meeting in December explore the outcomes of brain surgery for children with severe epilepsy.
One study created a decision analysis model to compare how two treatment strategies -medical treatment alone versus brain surgery -- influenced the life expectancy of pediatric patients with refractory epilepsy. Researchers at Boston Children's Hospital developed a decision analysis model with data from the literature. Their findings suggest that surgery increases the odds of a longer life expectancy, compared with medical treatment alone. For example, in a cohort of 10-year old patients, epilepsy surgery in patients with temporal lobe epilepsy yielded 55.2 years of life expectancy, while medical treatment yielded 49.3 years of life expectancy. In extratemporal epilepsy, surgery yielded 54.9 years of life expectancy while medical treatment only yielded 49.3 years. Authors note that the findings suggest that brain surgery is significantly more advantageous than medical treatment alone for eligible children with refractory epilepsy.
A second study examined the effectiveness of resective epilepsy surgery on seizure frequency in children with refractory epilepsy with features of Lennox-Gastaut Syndrome (LGS). Researchers studied 36 patients with LGS who had epilepsy surgery at the Cleveland Clinic for focal, lobar, multilobar resection or hemispherectomy between June 1, 2002 and June 31, 2012. Patients in this study developed epilepsy due to brain lesions or injuries sustained before they were born (17), immediately before or after they were born (10), or between the ages of 2 months and 3 years (9). At the time of surgery, the patients ranged in age from newborn to 18 years, and were experiencing multiple seizures per day.
At follow-up visits conducted 6 months to 6.6 years after surgery, 19 patients were seizure-free. Of the patients still experiencing seizures, two entered late remission 2 years after surgery and five became almost seizure-free, with an average of nine seizures per month. At the last follow-up visit, 24 patients were either seizure-free or had experienced a major reduction in seizure frequency.
"In the past, children with features of Lennox Gastatut syndrome were not considered to be candidates for epilepsy surgery that involves removal of the seizure focus," said Dr. Ahsan Moosa Naduvil, M.D., Staff, section of pediatric epilepsy, Cleveland Clinic Epilepsy Center. "Our study confirms that selected children with early brain lesions may be rendered seizure free with epilepsy surgery."
The authors performed a survival analysis based on the duration of time between seizures, and determined the chance of seizure freedom as 60.1% at 12 months, 51% at 24 months and 40.8% at 30 months or more. According to the authors, the findings suggest that resective epilepsy surgery is an effective treatment option for selected children with LGS secondary to early focal brain lesion or injury.
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