Article
Predictors of postoperative long-term seizure in 50 paediatric patients with focal cortical dysplasia type II – retrospective single-centre study
Prädiktoren für die postoperative Anfallsfreiheit in 50 pädiatrischen Patieten mit fokal-kortikalen Dysplasie Typ II – retrospektive Single-Center-Studie
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Published: | June 4, 2021 |
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Objective: Focal cortical dysplasia (FCD) is the most common reason for early-onset intractable epilepsy among children. Surgical resection is growing overtime to become highly sufficient treatment option. This study provides a retrospective analysis of preoperative and postoperative factors and their impact on postsurgical long-term seizure outcome.
Methods: Fifty pediatric patients with mean age of 8 years (SD: ±4.49) with histologically proven FCD type II were retrospectively analyzed regarding the long-term postsurgical outcome. Furthermore, the impact of demographic data, imaging characteristic and surgical outcome on the long-term seizure outcome was analyzed. The patients underwent clinical examinations and short-term EEG at 6 months and 12 months after surgery. The seizure outcome was evaluated based on the ILAE-Classification.
Results: Complete resection of FCD was achieved in 74% (n=37). One year after surgery ILAE class I was achieved in 72% (n=36) and the long-term outcome improved to 74% (n=37) class I. A reduction of anti-epileptic drugs (AED) to monotherapy or complete discharge of AED was achieved in 37% (n=19). Eighteen percent (n=9) had late seizure recurrence, 14% (n=7) occurred after reduction of AED. Younger age at time surgery (p<0.001), shorter duration of epilepsy (p<0.001), lower number of taken AED prior to surgery (p=0.023) and completeness of resection were positive prognostic factors for a better long-term seizure outcome.
Conclusion: Duration of epilepsy, completeness of resection, number of AED and younger Age at time of surgery serve as predictors for the postsurgical long-term seizure outcome. The factors help in the selection process of surgical candidates as well as provide a better presurgical patient counseling. An earlier evaluation for surgery in patients with FCD II could elevate the long-term seizure outcome.