PRE-SURGERY PHASE 1 EVALUATION RESULTS AND CONTRIBUTION TO SURGERY IN PEDIATRIC PATIENTS WITH DRUG-RESISTANT EPILEPSY
İlknur Cankurt, Tuğba Hirfanoğlu, Recep Kamil Kılıç, Esra Serdaroğlu, Ercan Demir, Ayşe Serdaroğlu, Ebru Arhan
Objective: Epilepsy surgery is an important treatment option in children with drug-resistant epilepsy. Preoperative evaluation of patients who are candidates for surgery; consists of non-invasive Phase 1 evaluation and Phase 2 studies with invasive evaluations added as needed. In phase 1 evaluation; long-term scalp video EEG monitoring (LTVEM) and brain magnetic resonance imaging (MRI) are performed. We aimed reveal the results of the Phase 1 evaluation of pediatric patients with refractory epilepsy in our Video EEG Monitoring Unit, which is a 3rd Level Epilepsy Surgery Center, and to determine the variables affecting the prognosis. Material/Methods: All patients who were monitored at LTVEM between 2013-2021 and evaluated in the epilepsy surgery council were retrospectively analyzed. Results: The data of 523 patients who were long-term monitored (LTVEM) were reviewed; 466 of them diagnosed with refractory epilepsy owing to radiological and ictal EEG records and evaluated. MRI was normal in 158 patients (33.9%). There were pathological lesions on MRI in 308 patients (66.1%) and localized lesions in 87 patients (18.6%). As a result of the LTVEM, pathological findings of 114 (24.4%) patients were lateralized and localized, however 243 (52.1%)of them were generalised/multifocal. Surgery was decided on 88 (18.8%) patients evaluated in the Epilepsy Surgery Council. VNS decision was taken in 141 (30.8%) patients who were not suitable for surgery. Conclusion: Surgical decision rate was 18.8% as a result of the phase 1 evaluation. Pediatric patients with focal refractory epilepsy can be treated safely with resective surgery, owing to the Phase 1 evaluation.
Keywords: drug resistant epilepsy, surgery, phase 1 evoluation
İlknur Cankurt
Gazi University Faculty of Medicine
Turkey
Tuğba Hirfanoğlu
Gazi University Faculty of Medicine
Turkey
Recep Kamil Kılıç
Gazi University Faculty of Medicine
Turkey
Esra Serdaroğlu
Gazi University Faculty of Medicine
Turkey
Ercan Demir
Gazi University Faculty of Medicine
Turkey
Ayşe Serdaroğlu
Gazi University Faculty of Medicine
Turkey
Ebru Arhan
Gazi University Faculty of Medicine
Turkey
Objective: Epilepsy surgery is an important treatment option in children with drug-resistant epilepsy. Preoperative evaluation of patients who are candidates for surgery; consists of non-invasive Phase 1 evaluation and Phase 2 studies with invasive evaluations added as needed. In phase 1 evaluation; long-term scalp video EEG monitoring (LTVEM) and brain magnetic resonance imaging (MRI) are performed. We aimed reveal the results of the Phase 1 evaluation of pediatric patients with refractory epilepsy in our Video EEG Monitoring Unit, which is a 3rd Level Epilepsy Surgery Center, and to determine the variables affecting the prognosis. Material/Methods: All patients who were monitored at LTVEM between 2013-2021 and evaluated in the epilepsy surgery council were retrospectively analyzed. Results: The data of 523 patients who were long-term monitored (LTVEM) were reviewed; 466 of them diagnosed with refractory epilepsy owing to radiological and ictal EEG records and evaluated. MRI was normal in 158 patients (33.9%). There were pathological lesions on MRI in 308 patients (66.1%) and localized lesions in 87 patients (18.6%). As a result of the LTVEM, pathological findings of 114 (24.4%) patients were lateralized and localized, however 243 (52.1%)of them were generalised/multifocal. Surgery was decided on 88 (18.8%) patients evaluated in the Epilepsy Surgery Council. VNS decision was taken in 141 (30.8%) patients who were not suitable for surgery. Conclusion: Surgical decision rate was 18.8% as a result of the phase 1 evaluation. Pediatric patients with focal refractory epilepsy can be treated safely with resective surgery, owing to the Phase 1 evaluation.
Keywords: drug resistant epilepsy, surgery, phase 1 evoluation
İlknur Cankurt
Gazi University Faculty of Medicine
Turkey
Tuğba Hirfanoğlu
Gazi University Faculty of Medicine
Turkey
Recep Kamil Kılıç
Gazi University Faculty of Medicine
Turkey
Esra Serdaroğlu
Gazi University Faculty of Medicine
Turkey
Ercan Demir
Gazi University Faculty of Medicine
Turkey
Ayşe Serdaroğlu
Gazi University Faculty of Medicine
Turkey
Ebru Arhan
Gazi University Faculty of Medicine
Turkey
İlknur Cankurt
Gazi University Faculty of Medicine
Turkey
Gazi University Faculty of Medicine
Turkey