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Temporal lobe epilepsy surgery in children and adults: A multicenter study
Author(s) -
Barba Carmen,
Cossu Massimo,
Guerrini Renzo,
Di Gennaro Giancarlo,
Villani Flavio,
De Palma Luca,
Grisotto Laura,
Consales Alessandro,
Battaglia Domenica,
Zamponi Nelia,
d’Orio Piergiorgio,
Revay Martina,
Rizzi Michele,
Casciato Sara,
Esposito Vincenzo,
Quarato Pier Paolo,
Di Giacomo Roberta,
Didato Giuseppe,
Pastori Chiara,
Pavia Giusy Carfi,
Pellacani Simona,
Matta Giulia,
Pacetti Mattia,
Tamburrini Gianpiero,
Cesaroni Elisabetta,
Colicchio Gabriella,
Vatti Giampaolo,
Asioli Sofia,
Caulo Massimo,
Marras Carlo Efisio,
Tassi Laura
Publication year - 2021
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16772
Subject(s) - hippocampal sclerosis , temporal lobe , epilepsy , medicine , epilepsy surgery , pediatrics , electroencephalography , epilepsy in children , odds ratio , retrospective cohort study , psychiatry
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.