Dados do Trabalho

Título

Prediction of seizure freedom following epilepsy surgery in children

Resumo

Introduction: Epilepsy surgery is the best treatment option for individuals with pharmacoresistant structural epilepsies. There is an attempt to establish nomograms to assess the postoperative prognosis for patients and assist in the decision for the procedure. In this work, an existing nomogram was applied to a cohort of children undergoing epilepsy surgery.

Materials and Methods: Data collection was carried out by reviewing the medical records of children and adolescents with pharmacoresistant epilepsy submitted to surgery in a tertiary hospital between 1998 and 2019. We excluded individuals undergoing hemispherectomy/hemispherotomy, resection including more than one lobe, with follow-up less than 2 years and incomplete data in the records. The possible outcome was calculated from the nomogram developed by Jehi et al. [1], considering the following data: duration of epilepsy, frequency of seizures, gender, presence of generalized tonic-clonic seizures, etiology, type of surgery, findings on brain MRI and EEG (location of seizures and interictal epileptic discharges). We considered Engel type I (free of disabling seizures after surgery) as the desired outcome. The analysis of agreement was calculated with Harrell's c-index. The SPSS 24.0 program was used for the statistical analysis.

Results: We obtained data from 59 patients with 2-year follow-up and 39 patients with 5 years follow up. Of the total of patients, 35 were female and 24 were male. The mean age at surgery was 11 years, with median time from the first seizure to the surgery of 8 years. Fifty-four (91.5%) patients had tonic-clonic seizures. At 2 years after the surgical procedure, 45 (76.2%) were free of disabling seizures and at 5 years, 27 (69.2%). The mean prediction of Engel I at 2 or 5 years follow up was respectively 69% and 62% for those free of seizures and 56% and 53% for those who remained with disabling seizures. The c-index at age 2 was 0,54 and at age 5 it was 0,52.

Discussion/Conclusion: In this study, the application of a stablished nomogram to children and adolescents submitted to epilepsy surgery demonstrated only a weak sensitivity to predict seizure freedom. The results show that nomograms developed for prediction of seizure freedom in adults following epilepsy surgery might not be suitable for children. More specific nomogram specific for children could improve the decision of epilepsy surgery in this specific age group.

References:
[1] Kwan P, Arzimanoglou A, Berg AT, et al., Epilepsia (51):1069-1077, 2010;
[2] Brodie MJ et al., Neurology (78):1548-1554, 2012;
[3] Kwan P, Brodie MJ. N Engl J Med., (342): 314-319, 2000;
[4] Berg AT, Shinnar S, Levy SR, et al., Neurology. (56):1445-1452, 2001;
[5] Meador KJ et al., J Epilepsy. (2): 21-25, 1989;
[6] Lara Jehi et al., doi: 10.1016/S1474-4422(14)70325-4.