Evaluation and outcomes of paediatric epilepsy surgery in Singapore: A single-centre audit

Authors

  • Tan Si Qi Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
  • Adeline Ngoh Seow Fen Department of Neurology, KK Women's and Children's Hospital, Singapore
  • Ng Wai Hoe 3Department of Neurosurgery, National Neuroscience Institute, Singapore
  • Xie Wanying Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
  • Janardhan Krishnappa Department of Neurology, KK Women's and Children's Hospital, Singapore
  • Nazima Binte Sahul Hamed Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
  • Tang Phua Hwee Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
  • Tchoyoson Lim Choie Cheio Department of Neuroradiology, National Neuroscience Institute, Singapore
  • Kenneth Chang Tou En Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
  • Lee Ming Department of Pathology, Singapore General Hospital, Singapore
  • Martha Kao I-Ming Nursing Clinical Services - Neurology, KK Women’s and Children’s Hospital, Singapore
  • David Low Chyi Yeu Department of Neurosurgery, National Neuroscience Institute, Singapore, Department of Neurosurgery, KK Women's and Children's Hospital, Singapore
  • Derrick Chan Wei Shih Department of Neurology, KK Women's and Children's Hospital, Singapore

DOI:

https://doi.org/10.54029/2021zpd

Keywords:

drug-refractory epilepsy, epilepsy surgery, focal epilepsy, paediatric epilepsy

Abstract

Background: Paediatric epilepsy surgery reduces seizure burden in drug-refractory epilepsy reducing long-term neurocognitive damage.

Methods: Single-centre retrospective audit of pre-surgical evaluations and outcomes of the paediatric epilepsy and epilepsy surgery programme over eleven years at KK Women’s and Children’s Hospital, Singapore. Data were collected based on National Institute of Neurological Disorders and Stroke Common Data Elements guidelines. Outcome was categorized using Engel classification scale, and favourable outcome defined as greater than 50% decrease in seizure frequency or drop attacks.

Results: Thirty-three children underwent epilepsy surgery, with mean follow-up 3.8±3.1 years. Median age at surgery was 10.9 years. Twenty-four children with focal epilepsy underwent resection of the epileptogenic focus, including lesionectomy (n=8), anterior temporal lobectomy (n=7), extratemporal lobectomy (n=7) and hemispherectomy (n=2). Nine children underwent corpus callosotomy for Lennox Gastaut Syndrome (n=8) and West Syndrome (n=1). Median hospital stay duration was ten days. All twenty-three focal epilepsy patients with minimum three-month follow-up achieved greater than 50% seizure reduction. Fifteen (65%) focal epilepsy patients achieved seizure-freedom (Engel Class IA) after first surgeries. Four patients required second surgeries, with two achieving seizure-freedom. Intraoperative MRI (iMRI) is beneficial. All nine corpus callosotomy patients (100%) achieved greater than 50% decrease in drop attacks. Number of antiepileptic drugs was weaned for 21/32 (66%) patients. Post-operative complications were low and some patients had anticipated neurological deficits. Outcomes were comparable to current literature.

Conclusions: In well-selected candidates with tailored evaluation, paediatric epilepsy surgery is a safe therapeutic option with favourable outcomes and can be performed across the entire paediatric age range.

Published

2021-10-01

Issue

Vol. 26 No. 3 (2021)

Section

Original Article