title: Changing profiles of pediatric epilepsy surgery candidates over time: A nationwide single-center experience from 1990 to 2011.
abstract: OBJECTIVE
  Over the past decades, the number of epilepsy surgeries in children has increased and indications for surgery have broadened. We studied the changes in patient characteristics between 1990 and 2011 in a nationwide cohort and related these to seizure outcome and postoperative medication status. Second, we tried to identify predictors for seizure outcome after pediatric epilepsy surgery.
  
  
  METHODS
  To study changes over time, we divided this retrospective cohort of 234 children into two consecutive time periods of 11 years, and statistically compared the epochs in terms of patient characteristics, surgical variables, complications, seizure outcome, and postoperative medication status. To identify predictors of postoperative seizure freedom, we performed univariable and multivariable logistic regression analyses.
  
  
  RESULTS
  The number of surgeries per year increased from an average of 5 in the first, to 16 in the past epoch. Over time, significantly more surgeries were performed for malformations of cortical development, and more patients underwent magnetoencephalography (MEG) and invasive monitoring. Four percent of patients had a serious complication. Complete seizure freedom (Engel class IA) at 2 years after surgery was achieved in 74% of patients, which did not change significantly over time. The proportion of patients who were free from seizures and antiepileptic medication 2 years after surgery significantly increased from 13% to 32%. Factors predictive of seizure recurrence were preoperative intracranial monitoring, multilobar surgery, etiology, and longer duration of epilepsy before surgery.
  
  
  CONCLUSIONS
  Although more complex cases were operated over time and medication was withdrawn earlier after surgery, success rates at 2 years remained stable. In combination with low complication rates, this underscores the efficacy and safety of pediatric epilepsy surgery. It is important to consider epilepsy surgery early, as longer duration of epilepsy increased the risk of postoperative seizure recurrence.
authors.affiliation: Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Herm J
authors.initials: HJ
authors.lastname: Lamberink
authors.affiliation: Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: Boshuisen
authors.affiliation: Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter C
authors.initials: PC
authors.lastname: van Rijen
authors.affiliation: Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Gosselaar
authors.affiliation: Department of (Child) Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D009493:Neurosurgery; D010372:Pediatrics; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: Changes in time; Epilepsy; Pediatric; Predictors; Surgery