Resective Epilepsy Surgery Reduces Seizures, Improves Social Functioning in Lennox-Gastaut Syndrome
Better social competence and adaptive behavior was achieved by seizure-free patients at post-surgery follow-ups compared with patients with persistent seizures (P <.05).
Resective epilepsy surgery is a viable option to help improve both seizure control and adaptive functioning in patients with Lennox-Gastaut syndrome, according to an article published in Pediatrics.
To evaluate the long-term outcomes for patients with Lennox-Gastaut syndrome who had undergone resective epilepsy surgery, researchers reviewed 90 patient case reports for surgeries performed at the Severance Children's Hospital from 2003 to 2014 and managed them for at least 2 years following. Patients were between 3 and 23.5 years old at the time of surgery (mean±SD: 9.3±4.4) with 0.7 to 20.1 years from the time of first seizure to surgery (7.2±4.3). The most common pathologic finding was malformation of cortical development, which was noted in 62.3% (n=57) of patients.
During the post-operative follow-up period, 50% (n=45) of patients had no seizures and 16.7% (n=15) had infrequent seizures. Of the 21 patients who underwent hemispherectomies, 71.4% (n=15) achieved seizure-free outcomes, compared with 45.1% (23 out of 51) of patients who underwent multilobar resections, and 38.9% (7 out of 18) of those who had single lobar resections. Among the 22.2% (n=20) of patients with negative findings on high-resolution MRIs, 40% (8 out of 20) became seizure-free following resective surgery. Better social competence and adaptive behavior, as indicated by social quotients, was achieved by seizure-free patients at both the second and third post-surgery follow-ups (2-3 years and 4-6 years, respectively) compared with patients with persistent seizures (P <.05).
The study investigators concluded that "[c]areful preoperative investigations can be used to steer the course of LGS in patients toward seizure-free status and better outcomes in adaptive functioning and social competence. Resective surgery should be actively used to treat patients with LGS with suspected focal epileptic pathology."
Kang JW, Eom S, Hong W, et al. Long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome [published online September 7, 2018]. Pediatrics. doi: 10.1542/peds.2018-0449