Navigation Links
Good outcomes with staged surgery for epilepsy in children
Date:1/27/2014

Philadelphia, Pa. (January 27, 2014) A staged approach to epilepsy surgerywith invasive brain monitoring followed by surgery in a single hospital stayis a safe and beneficial approach to treatment for complex cases of epilepsy in children, reports the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Staged epilepsy surgery with invasive electrode monitoring is safe in children with poorly localized medically refractory epilepsy," write Drs. Jonathan Roth and Howard Weiner of NYU Langone Medical Center, New York City, New York. Their 13-year review suggests that complication rates decrease further as surgeons gain experience with staged epilepsy surgery.

Staged Surgery for the Most Complex Cases of Childhood Epilepsy

From 1996 to 2009, the researchers performed staged surgery in 161 children with refractory epilepsy that could not be controlled with anti-seizure medications. The children averaged about seven years old. Most had "multifocal" epilepsy originating from more than one area of the brain, often related to a genetic condition called tuberous sclerosis complex.

In the staged approach, children underwent two or more surgical procedures for epilepsy during one hospital admission. The first step was invasive monitoringsurgery to place electrodes, which were used to map the "epileptogenic" areas of the brain from which seizure activity was originating.

Eighty percent of children subsequently underwent surgery to resect the epileptogenic brain areas. In a total of 200 hospitalizations, the children underwent nearly 500 surgical procedures for invasive monitoring, resection, and electrode removal. Dr. Roth and colleagues write, "Most children underwent only one admission, most of which included two or three surgeries."

The current study focused on the safety of staged epilepsy surgery. Complications occurred at rates expected for children undergoing neurosurgical procedures. This included serious but less-common complications, such as neurologic abnormalities and central nervous system infections; as well as minor complications such as bone absorption or noninfectious fevers. Twenty-five children had complications requiring surgery.

Benefits of Staged Surgeries Outweigh the Risks

"Notably, surgical experience appeared to lower the complication rate," Dr. Roth and coauthors write. Complications decreased from 30 percent during the first six years of the experience, to 15 percent in the last six years. Complication rates were similar in different subgroups of patients, including those with more surgeries or more hospital admissions.

Surgery is an important treatment option for epilepsy that does not respond to medications. However, in some complex cases, the epileptogenic area can't be readily identified or seizures are originating from multiple sites.

The authors' department has previously reported good outcomes with staged surgery for children with complex epilepsy, producing large reductions in seizures for most patients. However, this approach is still not widely used, perhaps reflecting concerns that it might lead to high complication rates.

The new analysis suggests that staged epilepsy surgery in children is "relatively safe," with no higher than expected types and rates of complications. However, "When considering the risk-benefit profile in these children with severe epileptic disorders, we found that the benefits outweigh the risks," Dr. Roth and colleagues write.

They believe the staged surgical approach is especially appropriate, given the high risks of severe and repeated seizures in complex childhood epilepsy. The researchers have no single explanation for the reduction in complications over their 13-year experience, but it may reflect close attention to key technical details and patient care routines.


'/>"/>

Contact: Connie Hughes
Connie.Hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health
Source:Eurekalert

Related medicine news :

1. In children born with severe heart defect, surgical management has little effect on neuro outcomes
2. Early treatment improves outcomes in rare, often undiagnosed form of encephalitis
3. Intensivists at night improve patient outcomes in some ICUs, says Pitt/UPMC team
4. Phone contact with nurses linked with better outcomes for women with gestational diabetes
5. Group B streptococcal meningitis has long-term effects on childrens developmental outcomes
6. Hospital volume and surgeon specialty influence patient outcomes
7. MDS researchers join forces to advance patient treatments and outcomes
8. Future reproductive outcomes for women who have had an ectopic pregnancy
9. Obesity, larger waist size associated with better outcomes in heart failure patients
10. ACL reconstruction technique improves outcomes in pediatric patients
11. Newer hip reconstruction technique provides good outcomes for athletes
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:7/27/2017)... ... July 27, 2017 , ... MEDsys ... Medicaid programs, Managed Care Organizations and Home Care Agencies, has been awarded CIO ... VinCENT, provides technology solutions to over 1,000 agencies and multiple State Medicaid and ...
(Date:7/27/2017)... ... 27, 2017 , ... GAFFEY Healthcare, a leading provider of ... to Vice President of Revenue Cycle Business Services and Suzanne Dusak to Vice ... executive officer (CEO). , Elrene has been with company since Oct 2014 and ...
(Date:7/27/2017)... ... 2017 , ... Healthy eating isn’t always easy. Currently, more than 80 percent of Americans fail ... overeat refined grains and sugar. This trend may help explain why the obesity rate seems ... obese. , As a culture, we seem to have food on the brain more. "We ...
(Date:7/27/2017)... ... July 27, 2017 , ... The Freedom from ... startup companies around 117 breakthrough inventions from 55 institutions, including the National Institutes ... Institute of Biomedical Imaging and Bioengineering), the United States Army, and more than ...
(Date:7/27/2017)... ... ... Cremations recently surpassed traditional burials for the first time in the U.S. ... with over 70% of Americans projected to choose cremation by 2030. , In line ... to celebrate the life of a lost loved one in different ways using their ...
Breaking Medicine News(10 mins):
(Date:7/12/2017)... is a revolutionary new product that relieves painful carpal tunnel syndrome ... affects more than 8 million people a year. Women suffer from ... methods of treating CTS are painful surgery, the use of NSAIDs ... ... a clear patch worn on the palm of the hand. It ...
(Date:7/11/2017)... , July 11, 2017 Zymo Research Corp., also known ... that can quantify biological aging in a precise manner using the myDNAge ... Steve Horvath , a professor of human genetics and biostatistics at the ... School of Public Health , Zymo Research,s proprietary DNAge ™ technology ... ...
(Date:7/11/2017)... Md. , July 11, 2017  The global ... estimated revenues of approximately $394.1 million in 2016.  Although ... trend of solid growth, in particular as a result ... clinical practice, and the recent introduction of a significant ... need for less-invasive testing of tumor biomarkers to guide ...
Breaking Medicine Technology: