LOCALIZATION EPILEPSY SURGERY IN CHILDREN AT THE VIETNAM NATIONAL CHILDREN’S HOSPITAL
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Abstract
Purpose: To describe some clinical manifestations and some characteristics of the epileptogenic lesion in children suffering from drug-resistant localization-related epilepsies. To retrospectively analyze the post-surgical outcome among these patients based upon Engel classifcation system.
Methods: Hundred and two patients, younger than 18 years, operated on from 2010 to 2021 and followed-up for at least 1 year were identifed at Vietnam National Children’s Hospital. Individualized microsurgical resections, aimed at removal of the epileptogenic lesion, were performed as indicated by the results of presurgical evaluations, which included videoelectroencephalographic monitoring, specialized MR Imaging and PETCT scan when needed.
Results: Some clinical characteristics: Male: 52,4%, Female: 47,6% Mean age at surgery: 82,8 months. Mean duration before surgery: 51,4 months. Mean age at seizure onset: 33,7 months. Seizure semeiology: simple partial seizure: 33%, complex partial seizure: 8.3%, partial seizure with 2nd generalization: 33% and generalized seizure: 25%. EEG abnormalities were ipsilateral to the epileptogenic lesion in 58,3 % of cases, contralateral in 8,3% and bilateral in 33,3 %. Anatomically, temporal lobe involvement accounted for 58,3% of cases, extra-temporal lobe and multi-lobar involvements accounted for the remaining 41.6%. Histopathologically, focal cortical dysplasia: 41,6%, low-grade tumors: 25%, hippocampal sclerosis: 8,3%, Rasmussen syndrome 16,6 % and unremarkable: 8,3 %. At post-surgical follow-up, 87 patients (83,3%) were seize-free, in Engel’s class IA & IIA. Temporal lobe group had the best outcome (with 71,4 % of cases had Engel class IA and 28,6% had Engel class IIA).
Conclusion: Drug-resistant localization-related epilepsies in children could be cured successfully by resective surgery in the majority of cases.
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Keywords
Drug-resistant localization-related epilepsies, Epileptogenic lesion, Presurgical evaluation, Epilepsy surgery, Outcome of epilepsy surgery
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