News from Philadelphia in the US explores a new approach to epilepsy surgery in children. Offering surgery in two or three stages during one hospital admission has shown strong results in complex cases
Many children who develop epilepsy find that their seizures are controlled with epilepsy medicines. However, some do not – and in these cases, surgery can be an effective treatment option.
This new study was published in the February issue of the journal Neurosurgery. It explored the idea of performing surgery in several stages in children with poorly localised medically refractory epilepsy. This means a child’s seizures cannot be controlled with medicines and it is difficult to pinpoint where in the brain seizures start.
The study explored surgery cases over a 13-year period between 1996 and 2009. During that time, the idea of performing surgery in several stages was used in 161 children. This approach usually involves three stages.
The first stage is invasive electrode monitoring. This means a child’s skull is opened up and electrodes are placed on the surface of the brain. The electrodes detect electrical activity and help surgeons pinpoint the source of the seizures.
The second stage is resection – where the surgeon removes the part of the brain where seizures start. The third stage is removing the electrodes. All three stages are done during one hospital stay.
Over the 13-year period, it seemed that surgeons gained more experience with the staged surgery technique. This resulted in better outcomes for the children who had been operated on, most with complex epilepsies. Complications as a result of surgery happened in 30 per cent of the children at the beginning of the study period. This figure reduced to 15 per cent by the end.
The staged surgery method did not show any increased percentage of complications, but is still used less commonly than more traditional methods. It has also shown strong results – with a large reduction in seizures for most children with complex epilepsies.