Seizure Freedom in Children with Pathology-Confirmed Focal Cortical Dysplasia

Anna Mrelashvili, Robert J. Witte, Elaine C Wirrell, Katherine C Nickels, Lily Wong-Kisiel

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective We evaluated the temporal course of seizure outcome in children with pathology-confirmed focal cortical dysplasia and explored predictors of sustained seizure freedom. Methods We performed a single-center retrospective study of children ≤18 years who underwent resective surgery from January 1, 2000 through December 31, 2012 and had pathology-proven focal cortical dysplasia. Surgical outcome was classified as seizure freedom (Engel class I) or seizure recurrence (Engel classes II-IV). Fisher exact and nonparametric Wilcoxon ranksum tests were used, as appropriate. Survival analysis was based on seizure-free outcome. Patients were censored at the time of seizure recurrence or seizure freedom at last follow-up. Results Thirty-eight patients were identified (median age at surgery, 6.5 years; median duration of epilepsy, 3.3 years). Median time to last follow-up was 13.5 months (interquartile range, 7-41 months). Twenty patients (53%) were seizure free and 26 patients (68%) attained seizure freedom for a minimum of 3 months. Median time to seizure recurrence was 38 months (95% confidence interval, 6-109 months), and the cumulative seizure-free rate was 60% at 12 months (95% confidence interval, 43%-77%). Clinical features associated with seizure freedom at last follow-up included older age at seizure onset (P =.02), older age at surgery (P =.04), absent to mild intellectual disability before surgery (P =.05), and seizure freedom for a minimum of 3 months (P <.001). Conclusion Favorable clinical features associated with sustained seizure freedom included older age at seizure onset, older age at surgery, absent or mild intellectual disability at baseline, and seizure freedom for a minimum of 3 months.

Original languageEnglish (US)
Pages (from-to)513-518
Number of pages6
JournalPediatric Neurology
Volume53
Issue number6
DOIs
StatePublished - 2015

Fingerprint

Malformations of Cortical Development
Seizures
Pathology
Age of Onset
Recurrence
Intellectual Disability
Confidence Intervals

Keywords

  • epilepsy surgery
  • focal cortical dysplasia
  • neuroimaging
  • pediatric epilepsy
  • presurgical evaluation
  • seizure freedom

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Neurology

Cite this

Seizure Freedom in Children with Pathology-Confirmed Focal Cortical Dysplasia. / Mrelashvili, Anna; Witte, Robert J.; Wirrell, Elaine C; Nickels, Katherine C; Wong-Kisiel, Lily.

In: Pediatric Neurology, Vol. 53, No. 6, 2015, p. 513-518.

Research output: Contribution to journalArticle

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abstract = "Objective We evaluated the temporal course of seizure outcome in children with pathology-confirmed focal cortical dysplasia and explored predictors of sustained seizure freedom. Methods We performed a single-center retrospective study of children ≤18 years who underwent resective surgery from January 1, 2000 through December 31, 2012 and had pathology-proven focal cortical dysplasia. Surgical outcome was classified as seizure freedom (Engel class I) or seizure recurrence (Engel classes II-IV). Fisher exact and nonparametric Wilcoxon ranksum tests were used, as appropriate. Survival analysis was based on seizure-free outcome. Patients were censored at the time of seizure recurrence or seizure freedom at last follow-up. Results Thirty-eight patients were identified (median age at surgery, 6.5 years; median duration of epilepsy, 3.3 years). Median time to last follow-up was 13.5 months (interquartile range, 7-41 months). Twenty patients (53{\%}) were seizure free and 26 patients (68{\%}) attained seizure freedom for a minimum of 3 months. Median time to seizure recurrence was 38 months (95{\%} confidence interval, 6-109 months), and the cumulative seizure-free rate was 60{\%} at 12 months (95{\%} confidence interval, 43{\%}-77{\%}). Clinical features associated with seizure freedom at last follow-up included older age at seizure onset (P =.02), older age at surgery (P =.04), absent to mild intellectual disability before surgery (P =.05), and seizure freedom for a minimum of 3 months (P <.001). Conclusion Favorable clinical features associated with sustained seizure freedom included older age at seizure onset, older age at surgery, absent or mild intellectual disability at baseline, and seizure freedom for a minimum of 3 months.",
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N2 - Objective We evaluated the temporal course of seizure outcome in children with pathology-confirmed focal cortical dysplasia and explored predictors of sustained seizure freedom. Methods We performed a single-center retrospective study of children ≤18 years who underwent resective surgery from January 1, 2000 through December 31, 2012 and had pathology-proven focal cortical dysplasia. Surgical outcome was classified as seizure freedom (Engel class I) or seizure recurrence (Engel classes II-IV). Fisher exact and nonparametric Wilcoxon ranksum tests were used, as appropriate. Survival analysis was based on seizure-free outcome. Patients were censored at the time of seizure recurrence or seizure freedom at last follow-up. Results Thirty-eight patients were identified (median age at surgery, 6.5 years; median duration of epilepsy, 3.3 years). Median time to last follow-up was 13.5 months (interquartile range, 7-41 months). Twenty patients (53%) were seizure free and 26 patients (68%) attained seizure freedom for a minimum of 3 months. Median time to seizure recurrence was 38 months (95% confidence interval, 6-109 months), and the cumulative seizure-free rate was 60% at 12 months (95% confidence interval, 43%-77%). Clinical features associated with seizure freedom at last follow-up included older age at seizure onset (P =.02), older age at surgery (P =.04), absent to mild intellectual disability before surgery (P =.05), and seizure freedom for a minimum of 3 months (P <.001). Conclusion Favorable clinical features associated with sustained seizure freedom included older age at seizure onset, older age at surgery, absent or mild intellectual disability at baseline, and seizure freedom for a minimum of 3 months.

AB - Objective We evaluated the temporal course of seizure outcome in children with pathology-confirmed focal cortical dysplasia and explored predictors of sustained seizure freedom. Methods We performed a single-center retrospective study of children ≤18 years who underwent resective surgery from January 1, 2000 through December 31, 2012 and had pathology-proven focal cortical dysplasia. Surgical outcome was classified as seizure freedom (Engel class I) or seizure recurrence (Engel classes II-IV). Fisher exact and nonparametric Wilcoxon ranksum tests were used, as appropriate. Survival analysis was based on seizure-free outcome. Patients were censored at the time of seizure recurrence or seizure freedom at last follow-up. Results Thirty-eight patients were identified (median age at surgery, 6.5 years; median duration of epilepsy, 3.3 years). Median time to last follow-up was 13.5 months (interquartile range, 7-41 months). Twenty patients (53%) were seizure free and 26 patients (68%) attained seizure freedom for a minimum of 3 months. Median time to seizure recurrence was 38 months (95% confidence interval, 6-109 months), and the cumulative seizure-free rate was 60% at 12 months (95% confidence interval, 43%-77%). Clinical features associated with seizure freedom at last follow-up included older age at seizure onset (P =.02), older age at surgery (P =.04), absent to mild intellectual disability before surgery (P =.05), and seizure freedom for a minimum of 3 months (P <.001). Conclusion Favorable clinical features associated with sustained seizure freedom included older age at seizure onset, older age at surgery, absent or mild intellectual disability at baseline, and seizure freedom for a minimum of 3 months.

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