Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997

doi:10.1111/j.1528-1157.1999.tb01592.x

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Wiley InterScience

Epilepsia

Volume 40 Issue 12, Pages 1740 - 1749

Published Online: 2 Aug 2005

Published on behalf of the International League Against Epilepsy (ILAE)

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Postoperative Seizure Control and Antiepileptic Drug Use in Pediatric Epilepsy Surgery Patients: The UCLA Experience, 1986–1997

Gary W. Mathern*§ ^∥ , Christopher C. Giza‡, Sue Yudovin‡, Harry V. Vinters†§ ^∥ , Warwick J. Peacock¶, D. Alan Shewmon‡ W. Donald Shields‡§

*Divisions of Neurosurgery, University of California, Los Angeles, Los Angeles, U.S.A. §The Mental Retardation Research Center, University of California, Los Angeles, Los Angeles, U.S.A. ^∥ The Brain Research Institute, University of California, Los Angeles, Los Angeles, U.S.A. ‡Divisions of Pediatric Neurology, University of California, Los Angeles, Los Angeles, U.S.A. †Divisions of Neuropathology, University of California, Los Angeles, Los Angeles, U.S.A. ¶Department of Neurosurgery, University of California, San Francisco, San Francisco, California, U.S.A.

Address correspondence and reprint requests to Dr. G. W. Mathern at Division of Neurosurgery, Reed Neurological Research Center, UCLA Medical Center, Los Angeles, CA 90095-1769, U.S.A. E-mail:gmathern@ucla.edu

KEYWORDS

Neurosurgery • Neuronal migration disorders • Hemispherectomy • Outcome • Development

ABSTRACT

Summary: Purpose: Young children with refractory symptomatic epilepsy are at risk for developing neurologic and cognitive disabilities. Stopping the seizures may prevent these disabilities, but it is unclear whether resective surgery is associated with adequate long-term seizure control.

Methods: This study determined pre- and postsurgery seizure frequency and antiepileptic drug (AED) use (6 months to 10 years) in children with symptomatic seizures from unilateral cortical dysplasia (CD; n = 64) and non-CD etiologies (i.e., ischemia, infection; n = 71), and compared them with older temporal lobe epilepsy (TLE; n = 31) patients with complex partial seizures.

Results: Compared with presurgery, postsurgery seizure frequencies were decreased for CD, non-CD, and TLE patients (p < 0.002), and there were no differences between the three groups from 6 to 24 months after surgery (p > 0.12). At 5 years after surgery, seizure frequencies were greater in CD compared with TLE cases (p = 0.009). Compared with presurgery, the number of AEDs declined after surgery in all three groups (p < 0.002), and positively correlated with seizure frequencies (p = 0.0001).

Conclusions: This study indicates that seizure relief and AED use after resective surgery for symptomatic CD and non-CD etiologies was comparable with complex partial TLE cases up to 2 years after surgery. Furthermore, at 5 years after surgery, CD patients had outcomes better than those before surgery, but worse than TLE cases. In young children, these findings support the concept that early removal of symptomatic pathologic substrates is associated with seizure control and reduced AED use, similar to that noted in older TLE cases up to 2 years after surgery. Seizure control may reduce the risk of developing the seizure-related encephalopathy associated with severe symptomatic early-onset childhood epilepsy.

Accepted June 17, 1999.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1528-1157.1999.tb01592.x About DOI