Acute seizures and long-term efficacy analysis after procedure in children and adolescents with frontal lobe epilepsy

Abstract

Objective To analyze the incidence of acute postoperative seizures (APOS), risk factors and long-term efficacy after surgery in children and adolescents with drug-refractory frontal lobe epilepsy (FLE). Methods From January 2009 to September 2011, 51 children and adolescents with drug-refractory FLE (aged ≤21 years) followed up for ≥3 years after resection of frontal lobe epileptic foci resection at the Department of Functional Neurosurgery, Beijing Xuawu Hospital, Capital Medical University were enrolled retrospectively. The risk factors for APOS after procedure and its effect on long-term efficacy were analyzed. Kaplan-Meier survival curves were used to analyze the rate of seizure-free of all patients after procedure. Results In 51 patients, 11 (21.6%) had APOS. Compared with the non-APOS group, the surgical sites in the posterior frontal-central region were more likely to have APOS (P=0.020). There were no significant differences in sex, age of onset, age at surgery, course of disease, whether secondary generalized tonic clonic seizures (sGTCS), preoperative MRI having lesions or not, interictal electroencephalogram (EEG) before and after procedure, whether buried intracranial electrode, side of operation, focal cortical dysplasia (FCD) between the 2 groups (P>0.05). All patients were followed up for 36 to 68 months (mean 48.5±10.3). During the follow-up period, none of seizures disappeared in the APOS group, and none of the 21 cases had seizures in the non-APOS group. There was significant difference (P=0.005). The proportion of seizure free in 51 patients at 6 months, 1, 2, 3, and 5 years were 54.9%, 49%, 43.1%, 41.2%, and 41.2%, respectively. Preoperative MRI showed that patients had clear frontal lobe lesions, and the ratio of postoperative 5 years without seizures was 50.0%. It was slightly higher than 33.3% of the patients with normal MRI, however there was no significant difference (P=0.169). Postoperative pathological results were patients with FCD, the ratio of postoperative 5 years seizure-free was 42.9%, and that of the patients with non-FCD was 40.0%. There was no significant difference (P=0.814). Conclusions The efficacy of long-term follow-up in FLE children and adolescents with APOS were poor after resection of the frontal lobe epileptic foci. The ratio of seizure free was 41.2% at 5 years after frontal lobectomy. Key words: Epilepsy, frontal lobe; Child; Adolescent; Neurosurgical procedures; Acute postoperative seizure; Long-term outcome