title: Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey.
abstract: OBJECTIVE The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier. METHODS Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe. RESULTS For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome. CONCLUSIONS The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.|Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hosoyama
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Mihara
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Usui
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
authors.forename: Koichi
authors.initials: K
authors.lastname: Baba
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Tottori
authors.affiliation: Department of Neurosurgery, Fujimoto General Hospital, Miyakonojo, Miyazaki; and.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Otsubo
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.|Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kashida
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Iida
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hirano
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hanaya
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001333:Automobile Driver Examination; D002648:Child; D002675:Child, Preschool; D004651:Employment; D004827:Epilepsy / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D017060:Patient Satisfaction; D012044:Regression Analysis; D012189:Retrospective Studies; D012919:Social Behavior; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: AED = antiepileptic drug; DQ = development quotient; EEG = electroencephalography; Engel class; FCD = focal cortical dysplasia; MEG = magnetoencephalography; MTS = medial temporal sclerosis; QOL = quality of life; epilepsy surgery; outcome; pediatrics; social participation