Clinical features and outcomes of resective surgery in children with frontal lobe epilepsy: The experience of children’s epilepsy center_Journal of Epilepsy

Authors：

ZHANG Xiaoyu ¹ , ZHANG Yanjiong ¹ , LU Xiaodong ¹ , WANG Xinhua ¹ , ZHOU Shuizhen ¹ , WANG Yi ¹ , ZHAO Rui ² , LI Hao ² , SHEN Jin ³ , ZHANG Dajiang ³ , MA Yangyang ⁴ ,  ZHOU Yuanfeng ¹

1. Department of Neurology, Children’s Hospital of Fudan University, Shanghai 201102, China;
2. Department of Neurosurgery, Shanghai 201102, China;
3. Department of Radiology, Shanghai 201102, China;
4. Department of Pathology, Shanghai 201102, China;

Corresponding author：

ZHOU Yuanfeng, Email: yuanfengzhou@fudan.edu.cn

Keywords：

Frontal lobe epilepsy; Children; Clinical feature; Resective surgery; Outcome

DOI：

10.7507/2096-0247.202203001

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Objective To investigate clinical features and surgical outcome in children with frontal lobe epilepsy by evaluating the correlation between the predictive factors and seizure freedom. Methods 18 children who underwent frontal lobe epileptogenic resection in the Epilepsy Center of the Children's Hospital of Fudan University between January 2017 and December 2019 with a minimum follow up of 2 year were analyzed retrospectively. Each patient was evaluated with detailed data to predict postsurgical seizure freedom by analysis of variance. Results Of the 18 patients, there were 11 males and 7 females, the age at surgery ranged from 21 months to 11 years old (6.8±2.73) and the duration of seizures was from 1 month to 9 years. 17 patients had focal seizures, while 1 had generalized epileptic spasm. In scalp EEG, interictal and initial ictal discharges were frontal in 11 and 9 cases, respectively. MRI was indicative of FCD in 10 cases, tumor in 2, tuberous sclerosis and gliosis lesion in 1 case each. 4 patients were MRI negative. 11 patients underwent epileptogenic lesion resections directly and 7 cases received depth electrodes implantation and underwent stereo-electroencephalography to localize epileptogenic zone. At follow-up of 2 years, 14 (77.8%) patients remained seizure-free (Engel Ⅰ), 1 (5.6%) had marked seizure reduction (Engel Ⅱ), 2 (11.0%) showed minor improvement (Engel Ⅲ), and only 1 (5.6%) showed no response (Engel Ⅳ). About predictors of seizure recurrence, there were no significant differences in gender, age at surgery, age of seizure onset, duration of epilepsy, lateralization of epileptogenic zone, positive MRI findings, interictal and ictal discharge, etiology, intellectual development and stereo-electroencephalography implantation, while significantly higher rates of seizure freedom correlated with complete the resection of the epileptogenic zone. Conclusions Focal cortical dysplasia is the most common cause in childhood with frontal lobe epilepsy and complete resection of the epileptogenic zone can lead to good seizure control outcome.

Citation： ZHANG Xiaoyu, ZHANG Yanjiong, LU Xiaodong, WANG Xinhua, ZHOU Shuizhen, WANG Yi, ZHAO Rui, LI Hao, SHEN Jin, ZHANG Dajiang, MA Yangyang, ZHOU Yuanfeng. Clinical features and outcomes of resective surgery in children with frontal lobe epilepsy: The experience of children’s epilepsy center. Journal of Epilepsy, 2022, 8(4): 293-297. doi: 10.7507/2096-0247.202203001 Copy

1.	Harvey AS, Cross JH, Shinnar S, et al. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia, 2008, 49(1): 146-155.
2.	Pinheiro-Martins AP, Bianchin MM, Velasco TR, et al. Independent predictors and a prognostic model for surgical outcome in refractory frontal lobe epilepsy. Epilepsy Res, 2012, 99(1-2): 55-63.
3.	Jeha LE, Najm I, Bingaman W, et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain, 2007, 130(Pt2): 574-584.
4.	Kral T, Kuczaty S, Blümcke I, et al. Postsurgical outcome of children and adolescents with medically refractory frontal lobe epilepsies. Childs Nerv Syst, 2001, 17(10): 595-601.
5.	Vachhrajani S, de Ribaupierre S, Otsubo H, et al. Neurosurgical management of frontal lobe epilepsy in children. J Neurosurg Pediatr, 2012, 10(3): 206-216.
6.	Ramantani G, Kadish NE, Mayer H, et al. Frontal lobe epilepsy surgery in childhood and adolescence: predictors of long-term seizure freedom, overall cognitive and adaptive functioning. Neurosurgery, 2018, 83(1): 93-103.
7.	Samuel PJ, Menon RN, Chandran A, et al. Seizure outcome and its predictors after frontal lobe epilepsy surgery. Acta Neurol Scand, 2019, 140(4): 259-267.
8.	Englot DJ, Wang DD, Rolston JD, et al. Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis. J Neurosurg, 2012, 116(5): 1042-1048.
9.	Simasathien T, Vadera S, Najm I, et al. Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol, 2013, 73(5): 646-654.
10.	Hirfanoglu T, Serdaroglu A, Kurt G, et al. Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center. Epilepsy Behav, 2016, 63: 67-72.

1. Harvey AS, Cross JH, Shinnar S, et al. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia, 2008, 49(1): 146-155.
2. Pinheiro-Martins AP, Bianchin MM, Velasco TR, et al. Independent predictors and a prognostic model for surgical outcome in refractory frontal lobe epilepsy. Epilepsy Res, 2012, 99(1-2): 55-63.
3. Jeha LE, Najm I, Bingaman W, et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain, 2007, 130(Pt2): 574-584.
4. Kral T, Kuczaty S, Blümcke I, et al. Postsurgical outcome of children and adolescents with medically refractory frontal lobe epilepsies. Childs Nerv Syst, 2001, 17(10): 595-601.
5. Vachhrajani S, de Ribaupierre S, Otsubo H, et al. Neurosurgical management of frontal lobe epilepsy in children. J Neurosurg Pediatr, 2012, 10(3): 206-216.
6. Ramantani G, Kadish NE, Mayer H, et al. Frontal lobe epilepsy surgery in childhood and adolescence: predictors of long-term seizure freedom, overall cognitive and adaptive functioning. Neurosurgery, 2018, 83(1): 93-103.
7. Samuel PJ, Menon RN, Chandran A, et al. Seizure outcome and its predictors after frontal lobe epilepsy surgery. Acta Neurol Scand, 2019, 140(4): 259-267.
8. Englot DJ, Wang DD, Rolston JD, et al. Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis. J Neurosurg, 2012, 116(5): 1042-1048.
9. Simasathien T, Vadera S, Najm I, et al. Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol, 2013, 73(5): 646-654.
10. Hirfanoglu T, Serdaroglu A, Kurt G, et al. Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center. Epilepsy Behav, 2016, 63: 67-72.

Journal of Epilepsy

Clinical features and outcomes of resective surgery in children with frontal lobe epilepsy: The experience of children’s epilepsy center

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