Epilepsy & behavior : E&B · 2025
Long-term seizure outcome in pediatric and adolescent patients receiving curative and palliative frontal lobe epilepsy surgery.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Tsai Ming-Chen, Starnes Keith, Fine Anthony L, Nickels Katherine C, Wirrell Elaine C, Van Gompel Jamie J, Miller Kai J, C Wong-Kisiel Lily
Аннотация
OBJECTIVES: Resective or ablative frontal lobe surgery is an established treatment for drug-resistant frontal lobe epilepsy (FLE) in pediatric and adolescent patients, typically performed with curative intent. Emerging evidence suggests potential benefit even when used with palliative intent, though long-term outcome data based on surgical intent remains limited.
METHODS: We retrospectively reviewed patients aged <19 years with drug-resistant FLE who underwent resective/ablative surgery at a single academic epilepsy surgery center (2008-2024). Patients with prior epilepsy surgery, multilobar surgery, <1 year of follow-up, or lack of research authorization were excluded. Seizure outcomes, recurrence patterns, and predictive factors were analyzed using survival analysis and Cox regression. Recurrence was classified as early (1 week to 2 years) or late (>2 years). Delayed seizure freedom was defined as seizure-free > 1 year before last follow-up after initial recurrence.
RESULTS: Of the 25 patients included, 8 were female, 19 White, and 3 Hispanic/Latino. Median follow-up was 74 months (IQR 25.5-155). Median age at surgery was 10.58 years (IQR 3.21-14.5). Surgical intent was curative in 20 patients and palliative in 5 patients. Seizure freedom at last follow-up was achieved in 65 % of curative cases and 20 % of palliative cases. Pre-operative status epilepticus (SE) was the only significant predictor of recurrence in the curative surgery group (p = 0.024). Recurrence occurred in 50 % of curative cases, with early recurrences often drug-resistant. Delayed seizure freedom was achieved in 15 % of curative cases, including two after reoperation. In the palliative group, 80 % achieved ≥50 % seizure reduction.
CONCLUSION: Curative FLE surgeries are effective for long-term seizure control in pediatric and adolescent patients, with pre-operative SE possibly predicting recurrence. Palliative surgeries also yield meaningful seizure reduction, supporting their use in selected patients. Early surgical referral and consideration for reoperation may improve long-term outcomes.
METHODS: We retrospectively reviewed patients aged <19 years with drug-resistant FLE who underwent resective/ablative surgery at a single academic epilepsy surgery center (2008-2024). Patients with prior epilepsy surgery, multilobar surgery, <1 year of follow-up, or lack of research authorization were excluded. Seizure outcomes, recurrence patterns, and predictive factors were analyzed using survival analysis and Cox regression. Recurrence was classified as early (1 week to 2 years) or late (>2 years). Delayed seizure freedom was defined as seizure-free > 1 year before last follow-up after initial recurrence.
RESULTS: Of the 25 patients included, 8 were female, 19 White, and 3 Hispanic/Latino. Median follow-up was 74 months (IQR 25.5-155). Median age at surgery was 10.58 years (IQR 3.21-14.5). Surgical intent was curative in 20 patients and palliative in 5 patients. Seizure freedom at last follow-up was achieved in 65 % of curative cases and 20 % of palliative cases. Pre-operative status epilepticus (SE) was the only significant predictor of recurrence in the curative surgery group (p = 0.024). Recurrence occurred in 50 % of curative cases, with early recurrences often drug-resistant. Delayed seizure freedom was achieved in 15 % of curative cases, including two after reoperation. In the palliative group, 80 % achieved ≥50 % seizure reduction.
CONCLUSION: Curative FLE surgeries are effective for long-term seizure control in pediatric and adolescent patients, with pre-operative SE possibly predicting recurrence. Palliative surgeries also yield meaningful seizure reduction, supporting their use in selected patients. Early surgical referral and consideration for reoperation may improve long-term outcomes.