Publication: Clinical outcome of epilepsy surgery of the temporal lobe in pediatric group : A retrospective cohort study
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Date
2021
Authors
Mispan, Mohd Khairun Mohd
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Abstract
Aim: This study was to identify seizure outcome following epilepsy surgery in pediatric group using Engel classification. We also identified histological and radiological findings of the study population. Finally we identified potential prognostic factor for seizure free outcome (Engel Class I).
Methods: This study was a retrospective cohort study over a period of 8 years from 1st January 2012 until 1st July 2019. Engel Outcome Classification was used to identify seizure outcome at immediate, 3-6 months and one year post operation. Age, sex, age of seizure onset, age of operation, body weight, number of antiepileptic medications pre and post operation, duration of stay in ICU and ward, MRI and histopathological findings and complications were noted. Analytically, Fisher Exact test was used for categorical data. Wilcoxon Signed rank test was used for continuous but not normally distributed data. In this study, Univariate Logistics regression is used to understand whether Engel Classification I can be predicted from categorical variables and numerical variables. A set p-value of <0.05 was considered of statistical significant.
Results: 29 pediatric patients met study criteria. The Mean time between seizure onset and surgery was 5.6 years. None invasive evaluation was used in all 29 patients during preoperative assessment. With the use of the Engel Outcome Classification, Engel 1 Outcome or Seizure Free was achieved in 28 patients (96.6%) at immediate follow up, 24 patients (82.8%) at 3-6 months follow up and 24 (82.8%) at 1-year follow up.
Hippocampal Sclerosis was present in 13 patients (44.8%). Tumours were present in 16
patients (55.2%). The complication proportion was 14.4%. Only 2 (6.9%) patients underwent reoperations. There is significant changes in post operative Anti Epileptic Medications (AEDs) reduction in this study (P= 0.006). Possible risk factor of seizure was suggestive for less recurrence of seizure which may become as a predictor to achieve to Engel I classification in this study (P= 0.052).
Conclusion: The surgery outcome of epilepsy surgery of the temporal lobe in pediatric group was remarkable in this study. Careful patients’ selection by multidisciplinary evaluations is mandatory. Seizure freedom was achieved successfully with acceptable complications rates.
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Keywords
Epilepsy surgery , Engel Outcome Classification