John Libbey Eurotext

Analysis of surgical strategies for children with epileptic spasms Volume 23, issue 1, February 2021

Figures

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Authors
1 Department of Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing, China
2 Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
* Correspondence: Wenjing Zhou Tsinghua University Yuquan Hospital, No.5, Shijingshan Road, Shijingshan District, Beijing, 100049, China

Objective

To investigate surgical prognostic factors in order to establish a surgical plan for children with drug-resistant epileptic spasms.

Methods

We retrospectively analysed 64 childrenwith drug-resistant spasms who were operated on in Beijing; the electroclinical features, surgical procedures, and surgical outcomes of these children were discussed in detail. We divided the seizure-free patients into several groups according to imaging, aetiology, and application of stereo-electroencephalography in order to investigate the extent of the various influencing factors.

Results

Fifty-three (82.8%) patients had favourable outcome, and 11 (17.2%) had unfavourable outcome. Based on the univariate analysis, the factors associated with favourable seizure outcome were interictal high γ frequency (χ 2 = 4.161; p = 0.041), concordance between MRI and interictal epileptic discharges (IEDs) (χ 2 = 6.148; p =0.013), and concordance between PET and IEDs (χ 2 = 4.281; p = 0.039). Concordance between MRI and IEDs (OR = 0.083, 95% CI = 0.014–0.483; p = 0.006) and continuous discharges on electrocorticography (OR = 0.109, 95% CI = 0.019–0.639; p = 0.014) were important factors associated with a favourable surgical outcome.

Significance

Resective surgery is an effective treatment for drug-resistant ES in children. A deeper understanding of the predictors of seizure outcome is beneficial for establishing a standard, one-stage resection procedure for spasms in order to benefit more patients who have not previously considered surgery. We propose a workflow for presurgical evaluation in children with epileptic spasms.