Improved outcomes in pediatric epilepsy surgery: The UCLA experience, 1986-2008

M. Hemb*, T. R. Velasco, M. S. Parnes, J. Y. Wu, J. T. Lerner, J. H. Matsumoto, S. Yudovin, W. D. Shields, R. Sankar, N. Salamon, H. V. Vinters, G. W. Mathern

*Corresponding author for this work

Research output: Contribution to journalArticle

129 Scopus citations

Abstract

OBJECTIVE: Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time. METHODS: Pediatric epilepsy surgery patients operated in the first 11 years (1986-1997; pre-1997) were compared with the second 11 years (1998-2008; post-1997) for differences in presurgical and postsurgical variables. RESULTS: Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, +16%), 1 (81%, +18%), 2 (77%, +19%), and 5 (74%, +29%) years, and more seizure-free patients were on medications at 0.5 (97%, +6%), 1 (88%, +9%), and 2 (76%, +29%), but not 5 (64%, +8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery. CONCLUSIONS: Improved technology and surgical procedures along with changes in clinical practice were likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients.

Original languageEnglish (US)
Pages (from-to)1768-1775
Number of pages8
JournalNeurology
Volume74
Issue number22
DOIs
StatePublished - Jun 1 2010

ASJC Scopus subject areas

  • Clinical Neurology

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    Hemb, M., Velasco, T. R., Parnes, M. S., Wu, J. Y., Lerner, J. T., Matsumoto, J. H., Yudovin, S., Shields, W. D., Sankar, R., Salamon, N., Vinters, H. V., & Mathern, G. W. (2010). Improved outcomes in pediatric epilepsy surgery: The UCLA experience, 1986-2008. Neurology, 74(22), 1768-1775. https://doi.org/10.1212/WNL.0b013e3181e0f17a