Authors (including presenting author) :
Chak WK (1), Wong ST (2), Mak SH (3), Lau HY(3), Lam SM (4), Ko LP (5), Cheung YT(6) Cheung TY(6), Wong SY (7), Tam WY (8), Wong WW(9), Lam YP (10), Fong WM (1), Lee HT (1), Mok PS (1),Ngan YY (1), Yuen CL (1), Wong LM(1)
Affiliation :
(1) Paediatrics and Adolescent Medicine, Tuen Mun Hospital (2) Neurosurgical Unit, Tuen Mun Hospital (3) Diagnostic Radiology & Nuclear Medicine Unit, Tuen Mun Hospital (4) Child and Adolescent Psychiatry, Tuen Mun Hospital (5) Physiotherapy Unit, Tuen Mun Hospital (6) Occupational Therapy Unit, Tuen Mun Hospital (7) Speech Therapy Unit, Tuen Mun Hospital (8) Psychobehavoural Unit, Tuen Mun Hospital (9) Electro-diagnostic Unit, Tuen Mun Hosiptal, 10) Prothesis & Orthrosis Unit, Tuen Mun Hosiptal
Introduction :
Around 20-30 precent of children with epilepsy are drug resistant, some of them could benefit from surgical treatment. There are published international guidelines for indications to referral of these patients for pre-surgical evaluation.
Objectives :
To retrospective study 1)Post-operative seizure outcome of curative epilepsy including temporal and extra-temporal lobe resective surgery, hypothalamic harmatoma surgery and disconnection surgery 2) Reduction of anticonvulsants usage after surgery. 3)Post-operative seizure outcome of palliative epilepsy surgery including vagus nerve stimulator implantation and corpus callosotomy. 4)Surgical complications
Methodology :
All paediatric patients with drug resistant epilepsy in our NTW cluster were included. Pre-surgical evaluation including MRI brain,routine EEG. Long Term Video EEG Monitoring, PET, Ictal SPECT etc. Each individual patient has been assessed by Epileptologist, Neurosurgeons, Child Psychiatrist, Neuropsychologist, Physiotherapist, Occupational Therapist, Speech Therapist, Prosthesis & Orthrosis Therapist etc. Each patient has been discussed in details in inter-disciplinary epilepsy case conference with Radiologist. Patients with concordant investigation results with identified epileptogenic focus underwent curative epilepsy surgery. Patients who were not candidates for curative surgery resorted either to optimise antionvulsants, ketogenic diet or vagus nerve stimulator Implantation or corpus callostomy. Post-operatively, each patient was followed up for any improvement in seizure and any change of anticonvulsants. Seizure outcome after curative epilepsy surgery was evaluated by Engel Classification (1.Engel Class I - seizure free 2.Engel Class II- rare seizures 3.Engel Class III- Worthwhile improvement 4.Engel Class IV - no whorthwile improvement) We documented change of anticonvulsants after curative epilepsy surgery by categorising into 1.Anticonvulsant free 2. Reduction of anticonvulsant 3.Anticonvulsant no change. We report the seizure outcome after palliative epilepsy surgery VNS and Corpus Callosotomy by categorising into 1)>75 % seizure reduction 2)50-75% seizure reduction 3)seizure no change
Result & Outcome :
80 patients underwent epilepsy surgeries from 2001 to 2022; 64 patient underwent curative surgeries aged from 9 to 19 years; follow-up duration from 1 to 16 years. Seizure outcome: Engel I 69%; Engel II 12%; Engel III 11%; Engel IV 8%. Anticonvulsant free 25%; Anticonvulsant reduction 46%; No change 29%. Percentage of patients achieved Engel I seizure outcome in different types of surgeries: Temporal 74%; Extratemporal 65%; Hypothalamic Harmatoma 50%; Disconnection 60%. 12 patients underwent VNS implantaton from 2013 to 2022. 3 patient had VNS reimplantation. Aged from 6 to 23 years; follow up duration from 0.7 to 9 years. 20 % patient had >75% seizure reduction; 40% patient had >50-75 % seizure reduction; 40 % had seizure no change. 4 patients underwent corpus callsotomy from 2009 to 2022 aged from 10-12 year, follow up duration from 1 to 13 years. 50 % patient had >75 % reduction of drop attack/ generalised seizure 25 % > 50-75 % seizure reduction and 25 % had seizure no change. Surgical complication including two patients intracranial hemorrhage need craniotomy for clot evacuation; one patient hydrocephalus need ventriculoperitoneal shunt; one patient unilateral lower limb motor weakness with partial recovery.
Our epilepsy surgery program service is safe and effective. Our post-operative seizure outcome is comparable with international expert paediatric epilepsy center result.
