[PS5-1A-2] Epilepsy surgery – back to basics
Introduction: Epilepsy surgery is an important yet underutilized treatment option for children with drug resistant epilepsy (DRE) in the Asian and Oceanian region.
Aim: To report outcome of presurgical work up for children with DRE seen in Hospital Kuala Lumpur and propose strategies to reduce surgical gap in this region.
Methods: 233 children with refractory epilepsy underwent presurgical assessment between 2012-2016, involving MRI brain and routine scalp EEG in all, prolonged video EEG in 187/233 (80%) and FDG-PET in 127/233 (55%). Motor & speech fMRI were infrequently performed. 50 children underwent surgery based on MRI and EEG findings only. 30 needed additional FDG-PET studies to confirm localization. The most common procedure was temporal lobectomy (39/80, 49%), followed by functional hemispherotomy (24%), focal resection (21%) and temporo-parieto-occipital disconnection (6%). Aetiologies were malformation of cortical development (30/80, 37%), tumours (24%), atrophy/stroke (19%), hippocampal sclerosis (15%), cortical tubers (4%) and Rasmussen syndrome (1%). 60/80 (75%) of the operated children are currently seizure free.
Discussion: Epilepsy surgery can be recommended to the majority of cases based on MRI and EEG findings only. Temporal lobectomy is the most common surgical procedure performed. These basic work-up and surgical procedure potentially could be implemented in resource limited settings to reduce the surgical gap.
Aim: To report outcome of presurgical work up for children with DRE seen in Hospital Kuala Lumpur and propose strategies to reduce surgical gap in this region.
Methods: 233 children with refractory epilepsy underwent presurgical assessment between 2012-2016, involving MRI brain and routine scalp EEG in all, prolonged video EEG in 187/233 (80%) and FDG-PET in 127/233 (55%). Motor & speech fMRI were infrequently performed. 50 children underwent surgery based on MRI and EEG findings only. 30 needed additional FDG-PET studies to confirm localization. The most common procedure was temporal lobectomy (39/80, 49%), followed by functional hemispherotomy (24%), focal resection (21%) and temporo-parieto-occipital disconnection (6%). Aetiologies were malformation of cortical development (30/80, 37%), tumours (24%), atrophy/stroke (19%), hippocampal sclerosis (15%), cortical tubers (4%) and Rasmussen syndrome (1%). 60/80 (75%) of the operated children are currently seizure free.
Discussion: Epilepsy surgery can be recommended to the majority of cases based on MRI and EEG findings only. Temporal lobectomy is the most common surgical procedure performed. These basic work-up and surgical procedure potentially could be implemented in resource limited settings to reduce the surgical gap.