Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;62(1):128-142.
doi: 10.1111/epi.16772. Epub 2020 Dec 1.

Temporal lobe epilepsy surgery in children and adults: A multicenter study

Carmen Barba  1 , Massimo Cossu  2 , Renzo Guerrini  1   3 , Giancarlo Di Gennaro  4 , Flavio Villani  5   6 , Luca De Palma  7 , Laura Grisotto  8 , Alessandro Consales  9 , Domenica Battaglia  10 , Nelia Zamponi  11 , Piergiorgio d'Orio  2   12 , Martina Revay  2 , Michele Rizzi  2 , Sara Casciato  4 , Vincenzo Esposito  4   13 , Pier Paolo Quarato  4 , Roberta Di Giacomo  5 , Giuseppe Didato  5 , Chiara Pastori  5 , Giusy Carfi Pavia  7 , Simona Pellacani  1 , Giulia Matta  1 , Mattia Pacetti  9 , Gianpiero Tamburrini  14 , Elisabetta Cesaroni  11 , Gabriella Colicchio  15 , Giampaolo Vatti  16 , Sofia Asioli  17 , Massimo Caulo  18 ; TLE Study Group; Carlo Efisio Marras  7 , Laura Tassi  2
Collaborators, Affiliations

Temporal lobe epilepsy surgery in children and adults: A multicenter study

Carmen Barba et al. Epilepsia. 2021 Jan.

Abstract

Objective: To assess seizure and cognitive outcomes and their predictors in children (<16 years at surgery) and adults undergoing temporal lobe epilepsy (TLE) surgery in eight Italian centers.

Methods: This is a retrospective multicenter study. We performed a descriptive analysis and subsequently carried out multivariable mixed-effect models corrected for multiple comparisons.

Results: We analyzed data from 511 patients (114 children) and observed significant differences in several clinical features between adults and children. The possibility of achieving Engel class IA outcome and discontinuing antiepileptic drugs (AEDs) at last follow-up (FU) was significantly higher in children (P = .006 and < .0001). However, percentages of children and adults in Engel class I at last FU (mean ± SD, 45.9 ± 17 months in children; 45.9 ± 20.6 months in adults) did not differ significantly. We identified different predictors of seizure outcome in children vs adults and at short- vs long-term FU. The only variables consistently associated with class I outcome over time were postoperative electroencephalography (EEG) in adults (abnormal, improved,odds ratio [OR] = 0.414, P = .023, Q = 0.046 vs normal, at 2-year FU and abnormal, improved, OR = 0.301, P = .001, Q = 0.002 vs normal, at last FU) and the completeness of resection of temporal magnetic resonance (MR) abnormalities other than hippocampal sclerosis in children (OR = 7.93, P = .001, Q = 0.003, at 2-year FU and OR = 45.03, P < .0001, Q < 0.0001, at last FU). Cognitive outcome was best predicted by preoperative performances in either age group.

Significance: Clinical differences between adult and pediatric patients undergoing TLE surgery are reflected in differences in long-term outcomes and predictors of failures. Children are more likely to achieve sustained seizure freedom and withdraw AEDs after TLE surgery. Earlier referral should be encouraged as it can improve surgical outcome.

Keywords: children; cognitive outcome; epilepsy surgery; seizure outcome; temporal lobe.

PubMed Disclaimer

References

REFERENCES

    1. Blumcke I, Spreafico R, Haaker G, Coras R, Kobow K, Bien CG, et al. Histopathological Findings in Brain Tissue Obtained during Epilepsy Surgery. N Engl J Med. 2017;377:1648-56.
    1. Harvey AS, Cross JH, Shinnar S, Mathern GW. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia. 2008;49:146-55.
    1. Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol. 2008;7:525-37.
    1. Baud MO, Perneger T, Rácz A, Pensel MC, Elger C, Rydenhag B, et al. European trends in epilepsy surgery. Neurology. 2018;91:e96-106.
    1. Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol. 2014;13:1114-26.

Publication types

MeSH terms

Substances

LinkOut - more resources