Is streamlined evaluation of children for epilepsy surgery possible?

Authors

  • Shekhar G. Patil,

    1. The National Centre for Young People with Epilepsy, Lingfield, United Kingdom
    2. Neurosciences Unit, UCL—Institute of Child Health, London, United Kingdom
    3. Epilepsy Unit
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  • J. Helen Cross,

    1. Neurosciences Unit, UCL—Institute of Child Health, London, United Kingdom
    2. Epilepsy Unit
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  • W. Kling Chong,

    1. Department of Radiology, and
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  • Stewart G. Boyd,

    1. Neurosciences Unit, UCL—Institute of Child Health, London, United Kingdom
    2. Epilepsy Unit
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  • William J. Harkness,

    1. Neurosciences Unit, UCL—Institute of Child Health, London, United Kingdom
    2. Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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  • Brian G. R. Neville,

    1. The National Centre for Young People with Epilepsy, Lingfield, United Kingdom
    2. Neurosciences Unit, UCL—Institute of Child Health, London, United Kingdom
    3. Epilepsy Unit
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  • Rod C. Scott

    1. The National Centre for Young People with Epilepsy, Lingfield, United Kingdom
    2. Neurosciences Unit, UCL—Institute of Child Health, London, United Kingdom
    3. Epilepsy Unit
    4. Radiology and Physics Unit, UCL—Institute of Child Health, London, United Kingdom
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Address correspondence to Dr. Rod C. Scott, Senior Lecturer in Paediatric Neurosciences and Honorary Consultant Paediatric Neurologist, Neurosciences Unit, UCL—Institute of Child Health, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP, United Kingdom. E-mail: r.scott@ich.ucl.ac.uk

Summary 

Background: The presurgical evaluation of children with intractable epilepsy includes evaluation by an experienced clinician, MRI, video EEG, and functional imaging techniques to localize seizure onset. However, the contributions of each investigation to surgical decision making has not been systematically assessed.

Method: Data used for decision on eligibility for surgery on 353 children was discussed at a presurgical multidisciplinary meeting and systematically recorded. The relationships between MRI, EEG, SPECT findings, and the probability of being offered epilepsy surgery were investigated retrospectively using a quick unbiased statistical tree (QUEST).

Results: Sixteen children were offered nonresective surgery. Of the remaining, 236 (70%) were offered resective surgery. The proportion of children with a localized lesion on MRI offered resective surgery was 92%[95% CI: 88 to 95%], and EEG telemetry did not modify decision making in this group (p < 0.001). In children with bilateral MRI changes or normal scan the probability of being offered resective surgery was 78% in those with localized ictal onset on EEG compared to 9% with nonlocalized EEG (p < 0.001). SPECT did not appear to systematically influence decision making in any group.

Conclusion: Children with medically intractable epilepsy and localized lesions on MRI may not necessarily need ictal EEG recordings or SPECT prior to offering resective surgery. More targeted use of EEG telemetry could allow more children with less obvious surgical targets to be investigated without increasing resources.

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