221. A Review Of Outcomes In Pediatric Resective Epilepsy Surgery Regarding Timing Of Surgical Treatment

Authors: Michael Timothy Bounajem; D. Samples, MD; Izabela Tarasiewicz, MD (San Antonio, TX)

Introduction

The treatment of pediatric epilepsy is a complex process, and typically begins with trials of antiepileptic drugs and step-up to multidrug therapy. Should multidrug therapy fail, epilepsy of certain etiologies can benefit from resective surgery. While it is often accepted that shorter latency to operation leads to better outcomes, there is still significant delay in offering surgery to these patients. Additionally, there is a paucity of studies detailing the benefits of early surgery.

Methods

A review of PubMed and Scopus articles was conducted using the following search criteria: Search ((time factors) AND neurosurgical procedures) AND epilepsy Filters: Child: birth-18 years. The initial search yielded 183 results. All 183 articles were systematically reviewed by title, abstract, and finally full text.

Results

Upon filtering by title to include outcomes analysis, the included articles decreased to 32. Review of abstracts excluded 25 articles, and the remaining seven were then analyzed. All but one article found a significant benefit from early progression to surgical treatment in medically refractory epilepsy. Patients were most often assessed by the Engel classification system, producing results that are easily comparable. Etiologies of epilepsy included temporal and extra-temporal lobe focal epilepsy, malformation of cortical development, and tuberous sclerosis.

Discussion

While there is limited literature available highlighting the benefits of early surgical timing in pediatric patients with medically refractory epilepsy, those available generally suggest better outcomes with early surgery. Better outcomes were also associated with temporal lobe epilepsy, as well as extra-temporal lobe epilepsy with etiologies such as malformation of cortical development and tuberous sclerosis. Further studies of surgical timing are necessary to produce convincing evidence of proper timing for resective surgery, and would assist in counseling patients on the most ideal direction of treatment when multidrug therapy fails.