Long-term Outcome of Resective Epilepsy Surgery in Patients With Lennox-Gastaut Syndrome

• Published in: Pediatrics (Evanston) Vol. 142; no. 4
• Main Authors: Kang, Joon Won, Eom, Soyong, Hong, William, Kwon, Hye Eun, Park, Soyoung, Ko, Ara, Kang, Hoon-Chul, Lee, Joon Soo, Lee, Young-Mock, Kim, Dong Seok, Kim, Heung Dong
• Format: Journal Article
• Language: English
• Published: United States 01.10.2018
• Subjects: Adolescent; Child; Child, Preschool; Cohort Studies; Electroencephalography - trends; Female; Follow-Up Studies; Humans; Lennox Gastaut Syndrome - diagnostic imaging; Lennox Gastaut Syndrome - physiopathology; Lennox Gastaut Syndrome - surgery; Magnetic Resonance Imaging - trends; Male; Neurosurgical Procedures - trends; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 1098-4275
• DOI: 10.1542/peds.2018-0449

We aimed to evaluate the long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome (LGS). We reviewed the case reports of 90 patients with LGS who had undergone resective surgery between 2003 and 2014 at the Severance Children's Hospital and managed them for a minimum period of 2 years. At the time of surgery, the patients were between 3.0 and 23.5 years old (mean ± SD: 9.3 ± 4.4). The time from seizure onset to surgery ranged from 0.7 to 20.1 years (7.2 ± 4.3). On postoperative follow-up for an average period of 6.1 ± 2.2 years (range: 2.1-11.4 years), 45 patients (50.0%) had no seizures, and 15 (16.7%) reported infrequent seizures. Seizure-free outcomes were achieved in 15 of the 21 (71.4%) hemispherectomies, 23 of the 51 (45.1%) multilobar resections, and 7 of the 18 (38.9%) single lobar resections. On high-resolution MRIs, 20 patients (22.2%) had negative findings, 8 of whom (40.0%) became seizure-free after resective surgery. Malformation of cortical development was the most common pathologic finding and was noted in 57 patients (63.3%). Seizure-free patients achieved better adaptive behavior and social competence than did patients with persistent seizures at the second (2-3 years after surgery) and third (4-6 years after surgery) follow-ups, as indicated by social quotients ( < .05). Resective surgery is a viable option in some patients to treat seizures that are associated with LGS, with a high probability of seizure control and better adaptive function.