Outcome of epilepsy surgery in children after evaluation with non-invasive protocol

• Published in: Neurology India Vol. 59; no. 1; pp. 30 - 36
• Main Authors: Jayalakshmi, Sita, Panigrahi, Manas, Kulkarni, Dilip Kumar, Uppin, Megha, Somayajula, Shanmukhi, Challa, Sundaram
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2011; Medknow Publications & Media Pvt. Ltd
• Subjects: Adolescent; Care and treatment; Child; Child, Preschool; Convulsions & seizures; Developing countries; Development and progression; Electrodes; Electroencephalography - methods; Epilepsy; Epilepsy - diagnostic imaging; Epilepsy - pathology; Epilepsy - surgery; Female; Follow-Up Studies; Health aspects; Hippocampus - pathology; Humans; Intelligence; LDCs; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Neurosurgery; Patient outcomes; Postoperative Period; Predictive Value of Tests; Retrospective Studies; Risk factors; Statistical analysis; Tomography; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Variables; Video Recording - methods; India
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/0028-3886.76854

To assess outcome of epilepsy surgery in children with medically refractory partial epilepsy evaluated with non-invasive protocol and to determine the predictors of outcome. Retrospective analysis of presurgical, surgical, and postsurgical data was performed in 87 children who had at least 1 year post surgery follow-up. Outcome was assessed according to Engel's outcome classification. Stepwise regression followed by logistic regression analysis was employed in data analysis. Mean follow-up was 32 (12-58) months and 44 (50.6%) were males. The age of onset of epilepsy was below the age of 2 years in 24 (30.8%). Resective surgery was done in 78 children. The commonest surgery performed was a temporal resection (88.9%) in adolescents and an extra-temporal resection ( 60.6%) in children. The commonest pathology was hippocampal sclerosis (HS) in adolescents and developmental, tumoral lesions, and gliosis in children. At last follow-up, 50 (64.1%) were seizure free and Engel's favourable outcome was noted in 59 (75.6%). After stepwise regression analysis, variables found to be significant (P < 0.05) and predicting a favourable outcome were lesion on MRI, normal IQ, and partial seizures without secondary generalization. Bilateral spikes on interictal EEG and acute postoperative seizures were predictors of poor outcome. A regression model was developed; the sensitivity, specificity, accuracy, and area under ROC curve were 82%, 91%, 88.5%, and 0.97%, respectively. Favourable outcome after epilepsy surgery can be obtained in children with temporal lobe epilepsy with HS and lesion-related epilepsies in developing countries with limited resources, after evaluation with a non-invasive protocol.