Resective epilepsy surgery in childhood: the Dutch experience 1992-2002.
OBJECTIVE
We present the outcome of resective epilepsy surgery in 69 pediatric patients who participated in the Dutch Collaborative Epilepsy Surgery Program (DCESP) between 1992 and 2002 with special emphasis on long-term follow-up.


METHODS
Sixty-nine children (aged 3 months to 17 years) operated on before 2003 were included in this study (34 temporal resections (49%), 17 extra-temporal resections (24%) and 19 hemispherectomies (27%)). Engel classification was used to assess seizure outcome annually. Cognitive outcome was assessed if possible. Two telephone surveys were carried out with an interval of 2(1/2) years to obtain data on seizure frequency, use of AEDs and on aspects op psychosocial development. Kaplan-Meier survival curves were constructed to assess recurrence of seizures after initial postsurgical seizure freedom, based on both telephone surveys.


RESULTS
Seventy percent scored Engel 1, 18% Engel 2, 6% Engel 3 and 6% Engel 4 at the time of the first telephone survey (2(1/2) years later: 77% Engel 1, 8% Engel 2, 12% Engel 3 and 3% Engel 4). Temporal resections were associated with the best seizure outcome (Engel 1 74% and 82%). AEDs could be withdrawn successfully in 53% of patients at time of the last follow-up. No negative impact on cognition was found. The first long-term follow-up (mean 4.5 years after surgery) measurement showed recurrence of seizures after initial seizure freedom in 17%. At time of the second long-term follow-up measurement (mean 7.5 years after surgery) this percentage had increased to 21%.


CONCLUSIONS
Our results support previous reports that surgery for intractable epilepsy in pediatric patients can be safely performed with satisfactory long-term results. Best results are attained in temporal resections.
Van Oijen
Marieke
M
Department of Child Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
De Waal
Hanneke
H
Van Rijen
Peter C
PC
Jennekens-Schinkel
Aag
A
van Huffelen
Alexander C
AC
Van Nieuwenhuizen
Onno
O
D000293:Adolescent; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003952:Diagnostic Imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D038421:Hemispherectomy; D006801:Humans; D007223:Infant; D007361:Intelligence Tests; D008134:Long-Term Care; D008297:Male; D009426:Netherlands; D019635:Neurosurgical Procedures / Q000523:psychology; D012640:Seizures / Q000601:surgery; D012919:Social Behavior; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome