Is streamlined evaluation of children for epilepsy surgery possible?

Full Abstract

BACKGROUND: The presurgical evaluation of children with intractable epilepsy includes evaluation by an experienced clinician, MRI, video EEG, and functional imaging techniques to localize seizure onset. However, the contributions of each investigation to surgical decision making has not been systematically assessed. METHOD: Data used for decision on eligibility for surgery on 353 children was discussed at a presurgical multidisciplinary meeting and systematically recorded. The relationships between MRI, EEG, SPECT findings, and the probability of being offered epilepsy surgery were investigated retrospectively using a quick unbiased statistical tree (QUEST). RESULTS: Sixteen children were offered nonresective surgery. Of the remaining, 236 (70%) were offered resective surgery. The proportion of children with a localized lesion on MRI offered resective surgery was 92%[95% CI: 88 to 95%], and EEG telemetry did not modify decision making in this group (p < 0.001). In children with bilateral MRI changes or normal scan the probability of being offered resective surgery was 78% in those with localized ictal onset on EEG compared to 9% with nonlocalized EEG (p < 0.001). SPECT did not appear to systematically influence decision making in any group. CONCLUSION: Children with medically intractable epilepsy and localized lesions on MRI may not necessarily need ictal EEG recordings or SPECT prior to offering resective surgery. More targeted use of EEG telemetry could allow more children with less obvious surgical targets to be investigated without increasing resources.

Author information

Author/s: Patil, Shekhar G (SG); Cross, J Helen (JH); Kling Chong, W (W); Boyd, Stewart G (SG); Harkness, William J (WJ); Neville, Brian G R (BG); Scott, Rod C (RC);

Affiliation: The National Centre for Young People with Epilepsy, Lingfield, United Kingdom.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Epilepsia (Epilepsia), published in United States. (Language: eng)

Reference: 2008-Aug; vol 49 (issue 8) : pp 1340-7

Dates: Created 2008/08/29; Completed 2008/09/18;

PMID: 18325011, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.