Five-Year Seizure Remission and AED Usage in Pediatric Epilepsy Surgery: The UCLA Experience

Keywords: epilepsy, anticonvulsant therapy, children, seizures, outcome

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     It is unclear if long-term outcomes after pediatric epilepsy surgery improve with experience and are comparable with adult seizure surgery.
     This study determined five-year long term seizure remission rates and anti-epilepsy drug (AED) from the University of California, Los Angeles Pediatric Epilepsy Surgery Program.
     Children less than age 18 years (1986 to 2005) where five-year outcome data should be available by 2010 were enrolled.
     Comparisons were made between patients with and without five-year data (n=338), cases with five year data for seizure outcome (n=257), and for seizure-free patients on and off anti-epilepsy drugs (AED; n=137).
     Five-year data was available from 76% of cases. Fewer patients with focal resections for hippocampal sclerosis and tumors had five-year data compared with other surgeries and etiologies. Patients were lost to follow-up after one-year, and most were seizure-free at last follow-up. Of those with five-year data, 53% were continuously seizure-free, 18% had late seizure recurrence, 3% became seizure-free after initial failure, and 25% were never seizure-free. Patients were more likely to be continuously seizure-free if their surgery was from 2001-2005 (68%) compared with 1996-2000 (61%), 1991-1995 (36%) and 1986-1990 (46%). More patients had a seizure per month or less in the late seizure recurrence (47%) compared with the not seizure-free group (20%). Four deaths were in the not seizure-free group and were seizure related compared with one death in the seizure free category. Of patients that were continuously seizure-free, 55% were not taking AEDs and more patients with cortical dysplasia had stopped AEDs (74%) compared with hemimegalencephaly (18%).
     This is a retrospective study.
     In pediatric patients, five-year seizure outcome improved with experience and is comparable with adult epilepsy surgery cases.
     Given the severe developmental disabilities and mortality associated with refractory epilepsy and the superior outcomes of surgery over continued medical therapy, children should promptly referred for consideration for surgical treatment. Surgery should not be the treatment of last resort in children with refractory epilepsy.


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