Dados do Trabalho

Título

CLINICAL AND EPIDEMIOLOGICAL PROFILE OF PEDIATRIC EPILEPSY SURGERY PATIENTS IN A REFERENCE CENTER IN BRAZIL OVER THE LAST 30 YEARS

Introdução

Pharmacoresistant epilepsy is a failure to achieve sustained seizure freedom despite the use of at least two tolerated and appropriately chosen anti-seizure medications. It accounts for about one third of patients with epilepsy. Given the deleterious consequences of refractory seizures, epilepsy surgery may be an option in this group of patients, either with a curative or palliative intent, with a therapeutic success around 60%. The epilepsy surgery consists in a disconnection or a resection of the epileptogenic area in order to improve seizure control.

Objetivo

To describe the epidemiological and clinical profile of pediatric patients submitted to epilepsy surgery in a reference center in Brazil over the last 30 years.

Método

This is a retrospective cohort study analyzing data from pediatric patients submitted to epilepsy surgery in a reference center in Brazil. The surgeries were performed from 1994 to 2024. The information analyzed was: demographic data, year of the surgery, age at surgery, epilepsy etiology, invasive monitoring, type of surgery, reoperation, Engel, time of follow-up and postoperative complications.

Resultados

This cohort included 632 pediatric patients, 361 (57.1%) of then were male and 271 (42.9%), female. The patients are originally from 327 Brazilian cities located in 24 different states. 718 surgeries were performed, with a mean of 29 surgeries per year. An important reduction in seizure number was noticed during the pandemic period (2020-2021). The mean age at epilepsy surgery was 10 years-old (2 months - 20 years-old). The most common etiologies were malformation of cortical development (32,5%), gliosis (14,3%), tumors (11,8%) and mesial temporal sclerosis (11%) 30% of patients underwent invasive monitoring, including electrocorticography subdural electrode and stereoelectroencephalography. The most common surgical procedures were: lobectomy (27,8%), hemispherotomy (24,9%), lesionectomy (23,3%) and lobar or multilobar disconnection (8%). 42,2% of the surgeries were multilobar and 50,8% involved the right hemisphere. The lobes operated were: temporal (35,3%), frontal (29,7%), parietal (17,7%), occipital (17,3%).

Conclusão

Our series show that epilepsy surgery can be performed in pediatric patients with manageable risks and good seizure outcome. It could provide a clear opportunity for better seizure control, therefore improving the neurodevelopment and the quality of life of these children and adolescents.

Referências

Pôster
1. Kwan, Patrick, et al. "Definition of drug resistant epilepsy: consensus proposal by the
ad hoc Task Force of the ILAE Commission on Therapeutic Strategies." (2010):
1069-1077.
2. Harvey, A. Simon, et al. "Defining the spectrum of international practice in pediatric
epilepsy surgery patients." Epilepsia 49.1 (2008): 146-155.
3. Laxer, Kenneth D., et al. "The consequences of refractory epilepsy and its treatment."
Epilepsy & behavior 37 (2014): 59-70.
4. Dwivedi, Rekha, et al. "Surgery for drug-resistant epilepsy in children." New England
Journal of Medicine 377.17 (2017): 1639-1647.

Palavras Chave

epilepsy; pediatric patients; surgery