Which children need epilepsy surgical treatment?
The development of imaging technology has made it possible to identify the “root cause” of many epilepsies that were previously unidentified. The more children and their families demand a higher level of diagnosis and treatment, the higher the quality of life.
The indications for epilepsy surgery need to be expanded accordingly, including.
(1) Refractory epilepsy.
The generally accepted definition is “epilepsy that has not been effectively controlled by regular drug therapy”. The timing of surgery should not be chosen too early or too late. Generally, adult patients with epilepsy need to be observed for at least two years and treated with at least two appropriate medications and still have more than one seizure per month before consideration, but this does not apply to certain children and adults with certain specific types of syndromes (described below).
(2) Secondary epilepsy.
The development of epilepsy neurosurgery cannot be separated from the advances in imaging technology. Many advanced imaging and neurophysiologic techniques are now able to identify many of the “responsible lesions” for the seizures. Removal or surgical isolation of these lesions can be used to cure or relieve seizures.
(3) Special types of epileptic syndromes.
Epilepsy with clear pathophysiologic changes predicts a poor prognosis for drug treatment. In addition, in consideration of brain development, because frequent interictal and seizure discharges significantly affect the brain development of children, coupled with the great plasticity of developing brain tissue, aggressive surgical treatment can not only reduce or control seizures, but also reduce the patient’s distant neurological deficits.
These common syndromes that are suitable for surgical treatment, called “surgically treatable epilepsy syndromes,” include
Medial temporal lobe epilepsy; neocortical epilepsy with clearly resectable lesions.
Types of epilepsy that are suitable for hemispherectomy in infancy and early childhood; hemiplegic convulsion syndrome; cerebral penetrating malformation; diffuse cortical dysplasia on one side; Sturge-weber syndrome; and Rasmussen encephalitis. In addition to recurrent seizures, patients with these syndromes have severe developmental delays as well as the potential for life-threatening conditions. Aggressive multi lobectomy or hemispherectomy can be effective in saving lives and avoiding more serious complications.
2. Those tests are indispensable before epilepsy surgery for children.
Three conditions are essential before epilepsy surgery: seizure performance + imaging performance + dynamic EEG examination. And the three must be consistent.
3. The concept of epileptic encephalopathy in children.
Clinically, we usually see some amazing situations: CT or MR of certain children show that a large part of the brain is destroyed and disappeared, but both intelligence and physical activity are no different from normal children, while CT or MR of many children with epilepsy show that most of the brain tissue is normal, but the level of intelligence and physical activity lags behind very significantly, and even continues to regress. This is another concept in epilepsy treatment – epileptic encephalopathy. Epileptic encephalopathy is a progressive brain dysfunction caused by frequent seizures and/or epileptiform discharges. In addition, the long-term use of antiepileptic drugs affects the physical and intellectual development level of the child.
4. In which hospitals are most epilepsy surgeries in children done.
Childhood epilepsy surgery must be performed by a group of neurosurgeons who are trained and experienced in pediatric epilepsy surgery.
The following three types of hospitals are commonly performed in China.
Pediatric neurosurgery at children’s hospitals affiliated with medical universities.
Neurosurgery centers in certain large general hospitals that also perform pediatric epilepsy surgery.
The neurosurgery department of some military hospitals.
5. What are the surgical options for children with epilepsy?
Epilepsy surgery includes resective surgery and functional surgery
Excisional surgery includes: anterior temporal lobectomy, anterior medial temporal lobectomy, selective amygdala and hippocampal resection, neocortical resection, multiple lobectomy, and cerebral hemisphere resection.
Functional surgery includes: corpus callosotomy, multiple submural transverse fiber dissection, low-power electrocoagulation thermal cautery, and vagus nerve stimulation.
6. What are the precautions to be taken after epilepsy surgery?
The first thing to do after epilepsy surgery is to relax your mind, not to be too tired and excited, and children should have their temperature controlled in time when they have fever; generally speaking, they should still take antiepileptic drugs for 2-3 years after surgery, and they should be used under the monitoring of the doctor.
7. What are the results of epilepsy surgery?
Seizures in the week after epilepsy surgery do not affect the long-term results of epilepsy surgery. The cure rate for rigorously screened epilepsy surgery is about 60%, with an efficiency rate of 70-80%.