Temporal lobe epilepsy surgery in children and adults: A multicenter study.
Adolescent
Adult
Age Factors
Anticonvulsants
/ therapeutic use
Child
Child, Preschool
Cognition
Early Medical Intervention
Electroencephalography
Epilepsy, Temporal Lobe
/ drug therapy
Female
Hippocampus
/ pathology
Humans
Male
Malformations of Cortical Development
/ pathology
Neuropsychological Tests
Neurosurgical Procedures
Postoperative Complications
/ epidemiology
Prognosis
Retrospective Studies
Sclerosis
Young Adult
children
cognitive outcome
epilepsy surgery
seizure outcome
temporal lobe
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
29
07
2020
revised:
11
10
2020
accepted:
04
11
2020
pubmed:
2
12
2020
medline:
20
4
2021
entrez:
1
12
2020
Statut:
ppublish
Résumé
To assess seizure and cognitive outcomes and their predictors in children (<16 years at surgery) and adults undergoing temporal lobe epilepsy (TLE) surgery in eight Italian centers. This is a retrospective multicenter study. We performed a descriptive analysis and subsequently carried out multivariable mixed-effect models corrected for multiple comparisons. We analyzed data from 511 patients (114 children) and observed significant differences in several clinical features between adults and children. The possibility of achieving Engel class IA outcome and discontinuing antiepileptic drugs (AEDs) at last follow-up (FU) was significantly higher in children (P = .006 and < .0001). However, percentages of children and adults in Engel class I at last FU (mean ± SD, 45.9 ± 17 months in children; 45.9 ± 20.6 months in adults) did not differ significantly. We identified different predictors of seizure outcome in children vs adults and at short- vs long-term FU. The only variables consistently associated with class I outcome over time were postoperative electroencephalography (EEG) in adults (abnormal, improved,odds ratio [OR] = 0.414, P = .023, Q = 0.046 vs normal, at 2-year FU and abnormal, improved, OR = 0.301, P = .001, Q = 0.002 vs normal, at last FU) and the completeness of resection of temporal magnetic resonance (MR) abnormalities other than hippocampal sclerosis in children (OR = 7.93, P = .001, Q = 0.003, at 2-year FU and OR = 45.03, P < .0001, Q < 0.0001, at last FU). Cognitive outcome was best predicted by preoperative performances in either age group. Clinical differences between adult and pediatric patients undergoing TLE surgery are reflected in differences in long-term outcomes and predictors of failures. Children are more likely to achieve sustained seizure freedom and withdraw AEDs after TLE surgery. Earlier referral should be encouraged as it can improve surgical outcome.
Substances chimiques
Anticonvulsants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
128-142Subventions
Organisme : Italian League Against Epilepsy Foundation
ID : Bando 2019
Investigateurs
Alfredo D'Aniello
(A)
Roberta Morace
(R)
Marco De Curtis
(M)
Francesca Deleo
(F)
Flavio Giordano
(F)
Alessandro De Benedictis
(A)
Giulia Prato
(G)
Marco Perulli
(M)
Informations de copyright
© 2020 International League Against Epilepsy.
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