Seizure outcome determinants in children after surgery for single unilateral lesions on magnetic resonance imaging: Role of preoperative ictal and interictal electroencephalography.

OBJECTIVE: To determine whether an ictal electroencephalographic (EEG) recording as part of presurgical evaluation of children with a demarcated single unilateral magnetic resonance imaging (MRI) lesion is indispensable for surgical decision-making, we investigated the relationship of interictal/ictal EEG and seizure semiology with seizure-free outcome. METHODS: Data were obtained retrospectively from consecutive patients (≤18 years old) undergoing epilepsy surgery with a single unilateral MRI lesion at our institution over a 6-year period. Video-telemetry EEG (VT-EEG) was classified as concordant or nonconcordant/noninformative in relation to the MRI lesion location. The odds of seizure-free outcome associated with nonconcordant versus concordant for semiology, interictal EEG, and ictal EEG were compared separately. Multivariate logistic regression was conducted to correct for confounding variables. RESULTS: After a median follow-up of 26 months (interquartile range = 17-37.5), 73 (69%) of 117 children enrolled were seizure-free. Histopathological diagnoses included low-grade epilepsy-associated tumors, n = 46 (39%); focal cortical dysplasia (FCD), n = 33 (28%); mesial temporal sclerosis (MTS), n = 23 (20%); polymicrogyria, n = 3 (3%); and nondiagnostic findings/gliosis, n = 12 (10%). The odds of seizure freedom were lower with a nonconcordant interictal EEG (odds ratio [OR] = .227, 95% confidence interval [CI] = .079-.646, p = .006) and nonconcordant ictal EEG (OR = .359, 95% CI = .15-.878, p = .035). In the multivariate logistic regression model, factors predicting lower odds for seizure-free outcome were developmental delay/intellectual disability and higher number of antiseizure medications tried, with a nonsignificant trend for "nonconcordant interictal EEG." In the combined subgroup of patients with FCD and tumors (n = 79), there was no significant relationship of VT-EEG factors and seizure outcomes, whereas in children with MTS and acquired lesions (n = 25), a nonconcordant EEG was associated with poorer seizure outcomes (p = .003). SIGNIFICANCE: An ictal EEG may not be mandatory for presurgical evaluation, particularly when a well-defined single unilateral MRI lesion has been identified and the interictal EEG is concordant.

Calidad de vida en pacientes con epilepsia refractaria controlados en un policlínico especializado en un hospital pediátrico / Quality of life in patients with refractory epilepsy controlled a polyclinic specializing in a pediatric hospital

Introducción: La epilepsia afecta la calidad de vida, tanto por la frecuencia de crisis como por factores relacionados a la atención, tratamiento, complicaciones, etc. Existen escalas para evaluación de este parámetro, como Encuesta de Calidad de Vida del niño con Epilepsia (CAVE). Objetivos: Evaluar calidad de vida en niños con Epilepsia Refractaria (ER), controlados en policlínico especializado. Determinar si atención en este policlínico mejora significativamente calidad de vida. Métodos: Se reclutaron pacientes de 0 a 18 años con ER, controlados en policlínico especializado, se aplicó encuesta CAVE en 2 oportunidades. Resultados: De los 35 pacientes, en la primera evaluación, 27 asistían al colegio, 20 presentaban autonomía catalogada como muy mala o mala, 20 evaluaban percepción de frecuencia de crisis como muy mala y mala, contrastando con opinión general de calidad de vida, donde 22 puntuaron en buena o muy buena. Al seguimiento, 2 iniciaron asistencia escolar, con mejoría significativa en percepción de intensidad de crisis, sin diferencias en otros ítems. Discusión: Se evaluó impacto de una intervención (policlínico especializado) en calidad de vida en ER mostrando una mejoría estadísticamente significativa solo en el parámetro percepción de intensidad de crisis, siendo necesario seguimiento a más largo plazo.

Introduction: Epilepsy affects the quality of life, both in seizure frequency as factors related to care, treatment, complications, etc. There are scales to evaluate this parameter, like Quality of Life in Children with Epilepsy (CAVE). Objectives: To evaluate quality of Life in children with Refractory Epilepsy (RE), controlled in a specialized polyclinic. To determine whether this specialized polyclinic care significantly improves quality of life. Patients and Methods: Patients were recruited from 0 to 18 years, with ER and in control in specialized polyclinic. They were surveyed with CAVE on 2 occasions in an 11 month period. Results: Of the 35 patients in the first evaluation, 27 were attending to school, 20 had self-classified as poor or very poor, 20 assessed perceived frequency of seizures as very bad and poor, in contrast to general opinion of quality of life, where 22 rated in good or very good. Monitoring, 2 began scholar assistance, with significant improvement in perceived intensity of crisis, no differences in other items. Discussion: We evaluate the impact of an intervention (specialized polyclinic) on Quality of Life in RE with a significantly improvement in intensity of crisis perception. It is necessary a long termfollow-up.