Pediatric epilepsy surgery and sudden unexpected death epilepsy: the contribution of a Brazilian epilepsy surgery program.
OBJECTIVE
Individuals with epilepsy are at higher risk of death than those from the general population, and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Epilepsies in the pediatric group are more frequently associated with known potentially risk factors for SUDEP, and a treatment resulting in an improved seizure control may also decrease mortality. The aim of this study is to identify the incidence of SUDEP in a group of operated-on children and adolescents.


METHODS
We analyzed 267 patients up to 18 years old, with medically intractable epilepsy submitted to surgery. We considered the age at surgery, the seizure type, the pathological findings, and the seizure outcome. Data were prospectively collected, according to the protocols of our institution's ethics committee.


RESULTS
The percentage of boys was 58.05. A good outcome was achieved in 72.6% of the cases and a bad outcome in 27.4%. Nine patients died during follow-up, six from clinical complications, and one from SUDEP. All patients who died during the long-term follow-up had persisted with refractory postoperative seizures. The patient who died from SUDEP died during a generalized tonic-clonic seizure.


CONCLUSIONS
Of the patients, 72.6% had excellent postoperative outcome, and one patient died of SUDEP. All patients who died had had disabling seizures' persistence. The surgical treatment of epilepsy in children and adolescents is an efficient therapy for the medically intractable symptomatic epilepsies and also for the reduction of mortality and SUDEP risks.
Terra
Vera C
VC
Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Centro de Cirurgia de Epilepsia, Ribeirão Preto, São Paulo, Brazil. v.c.terra@rnp.fmrp.usp.br
Scorza
Fulvio A
FA
Cavalheiro
Esper A
EA
Wichert-Ana
Lauro
L
Pinto
Kylvia G F D
KG
Machado
Helio R
HR
Sakamoto
Américo C
AC
D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003645:Death, Sudden / Q000453:epidemiology* / Q000209:etiology*; D004827:Epilepsy / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D019635:Neurosurgical Procedures; D016896:Treatment Outcome