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BACKGROUND: There is still some reluctance to refer pediatric patients for epilepsy surgery, despite evidence of success in retrospective series.
OBJECTIVE: To describe surgical experience and long-term outcome in pediatric temporal lobe epilepsy (TLE) at a single institution.
METHODS: Retrospective review of pediatric (< 18 years-old) TLE patients who underwent surgery between November 1996 and December 2006 at Cleveland Clinic Epilepsy Center. Cox-proportional hazard modeling was used to assess outcome predictors.
RESULTS: 130 pediatric patients met study criteria. Mean time between seizure onset and surgery was 6.3 years. Invasive evaluation was used in 32 patients (24.5%). Hippocampal sclerosis was present in 70 patients (53.8%), either alone or associated in dual pathology. The complication rate was 7%. The seizure-freedom rates at 1, 2, 5, and 12 years were 76%, 72%, 54%, and 41%, respectively (Kaplan-Meier). Using the Engel outcome classification, 98 (75.3%) patients were class I, 11 (8.5%) class II, 9 (7%) class III, and 12 (9.2%) were class IV at last follow-up. Only 4 (3.1%) patients were re-operated. Antiepileptic drugs (AED) were discontinued in 36 patients (28.3%) in a mean period of 18 months (SD +/- 17 months; range 6 to 102 months). Although left-sided resection, lower number of pre-operativeAED trials (<= 4), and tumor pathology correlated with favorable seizure outcomes, extensive surgical resection remained the only significant outcome predictor after multivariate analysis [p=0.007; HR=0.13 (95% C.I. 0.007-0.64)].
CONCLUSION: Careful selection of surgical candidates by multidisciplinary evaluations is required. Long-term seizure control is achieved successfully with acceptable low complication rates.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
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