Outcome of Epilepsy Surgery in Children in Semarang, Central Java, Indonesia

Indra Jaya, Alifiani Hikmah Putranti, M.Thohar Arifin, Zainal MuttaqinDr. Kariadi General Hospital, Semarang, IndonesiaOutcome of Epilepsy Surgery in Children in Semarang, Central Java, IndonesiaIntroduction 1Epilepsy surgery : indicated for patients with medically refractory epilepsy. Children with epilepsy : 10 - 40% medically refractory epilepsy SurgeryIntroduction 2Medically refractory epilepsy: seizures that are not controlled after an adequate trial with 2 first-line AEDs. International League Against Epilepsy : a failure of adequate trials of two tolerated and appropriately chosen and used AED schedules (whether as monotherapies or in combination) to achieve a sustainable free of seizure Introduction 3 Advances in neuroimaging technologies, more than 50% of patients with refractory epilepsy epilepsy surgery Objective To assess the outcome of epilepsy surgery in children.Method

Retrospective study between January 2000 and March 2012Subjects : 32 children with epilepsy age: 2-16 years at surgeryat least 4 months post-surgery follow-upRESULTTable 1. Characteristics of subjects Characteristics MeanAge at surgery (years)Age at onset (years)Follow up (month)12.9 6.4 60.6

Table 2. Characteristics of subjectsCharacteristics

Percentage (%)

Sex Male FemaleSeizure frequency before surgery < 5 attacks monthly 5 10 attacks monthly > 10 attacks monthlyType seizure : GTCS CPS OthersNeuroimaging abnormality : mesial temporal sclerosis50 50

59.43.137.5

6.378.115.681.2562.5

Fig . 1. Types of surgery

Table 2. : Postsurgical outcome Outcome Percentage (%) Seizure free :

anti-epileptic drugs (AED) discontinuation

postoperative mortality81.3

56.25

0Fig 2 : Post surgical AEDs among Free Seizure ChildrenOutcome

After epilepsy surgeries :Seizure free : 26 (81,3%) childrenDiscontinuation of an anti-epileptic drugs (AED) : 18 (56.25%) children No postoperative mortalityDiscussionTisi JD, 2010 used survival methods 52% of patients remained seizure free at 5 years after surgery, and 47% (4251) at 10 years.Jayalakshmi S et al, 2011 have studied indicates that surgery is a valuable option to treat children with drug-resistant focal epilepsies, with 75.6% being free of disabling seizures

Our study : seizure free outcome was noted in 81,3%, 56.25% children have discontinuation of anti-epileptic drugs (AED)The MRI brain was mesial temporal sclerosis in 20 (62.5%)

ConclusionFavourable outcome after epilepsy surgery can be obtained in children with medically refracter epilepsy.Epilepsy surgery is an effective and safe therapeutic modality in children with epilepsy

SUGGESTION Should be measured other outcomes :developmental and cognitive, behavioral and psychosocial, improvement in health-related quality of life (HRQOL).THANK YOU

ILAE classification system Click to add text

Outcome Classification 1

Outcome classification 2

Outcome classification 3

Outcome classification 4

Outcome classification 5

Outcome classification 6Completely seizure free; no auras

Only auras; no other seizures

1 to 3 seizure days per year; auras

4 seizure days per year to 50% reduction of baseline seizure days; auras

Less than 50% reduction of baseline seizure days; aurasMore than 100% increase of baseline seizure days; auras