Unilobar surgery for symptomatic epileptic spasms

Carmen Barba, Roberto Mai, Laura Grisotto, Francesca Gozzo, Simona Pellacani, Laura Tassi, Stefano Francione, Flavio Giordano, Francesco Cardinale, Renzo Guerrini

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Abstract

OBJECTIVE: To assess factors associated with favorable seizure outcome after surgery for symptomatic epileptic spasms and improve knowledge on pathophysiology of this seizure type.

METHODS: Inclusion criteria were: (1) age between 6 months and 15 years at surgery; (2) active epileptic spasms; (3) follow-up after surgery >1 year.

RESULTS: We retrospectively studied 80 children (aged 1.3 ± 2 years at seizure onset; 5.8 ± 4 years at surgery, 11.7 ± 5.7 years at last follow up). Magnetic resonance imaging (MRI) revealed structural abnormalities in 77/80 patients (96.3%; unilateral in 69: 89.6%). We performed invasive recordings in 24 patients (30%). In 21 patients in whom MRI or histopathology detected a lesion, electrodes exploring it constantly captured initial ictal activity at spasm onset. Fifty-eight patients (72.5%) underwent unilobar and 22 (27.5%) multilobar or hemispheric procedures. At last follow-up, 49 patients (61.3%) were in Engel class I. Multivariate logistic models showed completeness of resection of the seizure onset zone (OR = 0.016, 95%CI: 0.002, 0.122) and of the MRI visible lesion (OR = 0.179, 95% CI: 0.032, 0.999) to be significantly associated with Engel class IA outcome. Unfavorable outcome was associated with an older age at surgery, when it reflected a longer duration of epilepsy (OR = 1.383, 95% CI: 0.994,1.926).

INTERPRETATION: Data emerging from invasive recordings and the good seizure outcome following removal of discrete epileptogenic lesions support a focal cortical origin of spasms. In patients with discrete epileptogenic lesions, the pragmatic approach to surgery should follow the same principles applied to focal epilepsy favoring, whenever possible, unilobar, one-stage resections.

Original languageEnglish
Pages (from-to)36-45
Number of pages10
JournalAnnals of Clinical and Translational Neurology
Volume4
Issue number1
DOIs
Publication statusAccepted/In press - Oct 11 2016

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Barba, C., Mai, R., Grisotto, L., Gozzo, F., Pellacani, S., Tassi, L., Francione, S., Giordano, F., Cardinale, F., & Guerrini, R. (Accepted/In press). Unilobar surgery for symptomatic epileptic spasms. Annals of Clinical and Translational Neurology, 4(1), 36-45. https://doi.org/10.1002/acn3.373