Current state of hemispherectomy and callosotomy for pediatric refractory epilepsy in Denmark

IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY
Victoria Elizabeth De Knegt , Malene Landbo Børresen , Marianne Knudsen , Katrine Moe Thomsen , Peter Vilhelm Uldall , Anne Vagner Jakobsen , Christina Engel Hoei-Hansen
{"title":"Current state of hemispherectomy and callosotomy for pediatric refractory epilepsy in Denmark","authors":"Victoria Elizabeth De Knegt ,&nbsp;Malene Landbo Børresen ,&nbsp;Marianne Knudsen ,&nbsp;Katrine Moe Thomsen ,&nbsp;Peter Vilhelm Uldall ,&nbsp;Anne Vagner Jakobsen ,&nbsp;Christina Engel Hoei-Hansen","doi":"10.1016/j.braindev.2023.11.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate outcomes from hemispherectomy and callosotomy related to the need for anti-seizure medication (ASM), seizure frequency, and cognition.</p></div><div><h3>Methods</h3><p>A review of the medical charts of all Danish pediatric patients who underwent hemispherectomy or callosotomy from January 1996 to December 2019 for preoperative and postoperative ASM use, seizure frequency, and cognitive data.</p></div><div><h3>Results</h3><p>The median age of epilepsy onset was two years (interquartile range (IQR): 0.0–5.3) for the hemispherectomy patients (n = 16) and one year (IQR: 0.6–1.7) for callosotomy patients (n = 5). Median time from onset to final surgery was 3.4 years for hemispherectomy and 10.2 years for callosotomy, while the median follow-up time was 6.9 years and 9.0 years, respectively. Preoperatively, all patients had daily seizures and were treated with ≥ 2 ASM. Hemispherectomy resulted in a reduction in seizure frequency in 87.5 % of patients, with 78.6 % achieving seizure freedom. Furthermore, 81.3 % experienced a reduction in ASM use and 56.3 % stopped all ASM. Median IQ/developmental quotient (IQ/DQ) was low preoperatively (44.0 [IQR: 40.0–55.0]) and remained unchanged postoperatively (IQ change: 0.0 [IQR: −10.0–+4.0]). Callosotomy resulted in a seizure reduction of 86–99 % in four patients, and ASM could be reduced in three patients. Median IQ/DQ was 20.0 preoperatively (IQR: 20.0–30.0) and remained unchanged postoperatively (IQ change: 0.0 [IQR: 0.0]).</p></div><div><h3>Conclusion</h3><p>Hemispherectomy and callosotomy result in a substantial reduction in seizure frequency and ASM use without deterioration of IQ. Extensive epilepsy surgery should be considered early in children with drug-resistant epilepsy.</p></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2023-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain & Development","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0387760423001791","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective

To evaluate outcomes from hemispherectomy and callosotomy related to the need for anti-seizure medication (ASM), seizure frequency, and cognition.

Methods

A review of the medical charts of all Danish pediatric patients who underwent hemispherectomy or callosotomy from January 1996 to December 2019 for preoperative and postoperative ASM use, seizure frequency, and cognitive data.

Results

The median age of epilepsy onset was two years (interquartile range (IQR): 0.0–5.3) for the hemispherectomy patients (n = 16) and one year (IQR: 0.6–1.7) for callosotomy patients (n = 5). Median time from onset to final surgery was 3.4 years for hemispherectomy and 10.2 years for callosotomy, while the median follow-up time was 6.9 years and 9.0 years, respectively. Preoperatively, all patients had daily seizures and were treated with ≥ 2 ASM. Hemispherectomy resulted in a reduction in seizure frequency in 87.5 % of patients, with 78.6 % achieving seizure freedom. Furthermore, 81.3 % experienced a reduction in ASM use and 56.3 % stopped all ASM. Median IQ/developmental quotient (IQ/DQ) was low preoperatively (44.0 [IQR: 40.0–55.0]) and remained unchanged postoperatively (IQ change: 0.0 [IQR: −10.0–+4.0]). Callosotomy resulted in a seizure reduction of 86–99 % in four patients, and ASM could be reduced in three patients. Median IQ/DQ was 20.0 preoperatively (IQR: 20.0–30.0) and remained unchanged postoperatively (IQ change: 0.0 [IQR: 0.0]).

Conclusion

Hemispherectomy and callosotomy result in a substantial reduction in seizure frequency and ASM use without deterioration of IQ. Extensive epilepsy surgery should be considered early in children with drug-resistant epilepsy.

丹麦儿童顽固性癫痫的半球切除术和胼胝体切开术的现状。
目的:评价脑半球切除术和胼胝体切开术与抗癫痫药物需求、癫痫发作频率和认知能力的关系。方法:回顾1996年1月至2019年12月接受半球切除术或胼胝体切开术的所有丹麦儿科患者的病历,包括术前和术后ASM使用、癫痫发作频率和认知数据。结果:脑半球切除术患者(n = 16)癫痫发病年龄中位数为2年(IQR: 0.0 ~ 5.3),胼胝体切开术患者(n = 5)癫痫发病年龄中位数为1年(IQR: 0.6 ~ 1.7)。脑半球切除术和胼胝体切开术患者从发病到最终手术的中位数时间分别为3.4年和10.2年,中位数随访时间分别为6.9年和9.0年。术前,所有患者每日癫痫发作,治疗≥2 ASM。半球切除术导致87.5%的患者癫痫发作频率降低,78.6%的患者癫痫发作自由。此外,81.3%的人减少了ASM的使用,56.3%的人停止了所有ASM。中位智商/发育商(IQ/DQ)术前低(44.0 [IQR: 40.0-55.0]),术后保持不变(IQ变化:0.0 [IQR: -10.0-+4.0])。胼胝体切开术使4例患者癫痫发作减少86- 99%,3例患者ASM减少。中位IQ/DQ术前为20.0 (IQR: 20.0 ~ 30.0),术后保持不变(IQ变化:0.0 [IQR: 0.0])。结论:脑半球切除术和胼胝体切开术可显著降低癫痫发作频率和ASM的使用,而不降低智商。耐药癫痫患儿早期应考虑进行广泛的癫痫手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Brain & Development
Brain & Development 医学-临床神经学
CiteScore
3.60
自引率
0.00%
发文量
153
审稿时长
50 days
期刊介绍: Brain and Development (ISSN 0387-7604) is the Official Journal of the Japanese Society of Child Neurology, and is aimed to promote clinical child neurology and developmental neuroscience. The journal is devoted to publishing Review Articles, Full Length Original Papers, Case Reports and Letters to the Editor in the field of Child Neurology and related sciences. Proceedings of meetings, and professional announcements will be published at the Editor''s discretion. Letters concerning articles published in Brain and Development and other relevant issues are also welcome.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信