(Press-News.org) Contact information: Connie Hughes
Connie.Hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health
Good outcomes with staged surgery for epilepsy in children
2-step approach allows localization and resection in complex cases, reports Neurosurgery
Philadelphia, Pa. (January 27, 2014) – A staged approach to epilepsy surgery—with invasive brain monitoring followed by surgery in a single hospital stay—is 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 monitoring—surgery 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.
###
About Neurosurgery
Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.
About Wolters Kluwer Health
Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health's customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of €3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.
Good outcomes with staged surgery for epilepsy in children
2-step approach allows localization and resection in complex cases, reports Neurosurgery
2014-01-27
ELSE PRESS RELEASES FROM THIS DATE:
Mayo Clinic study finds standardized protocol and surgery improve mortality outcomes
2014-01-27
MANKATO, Minn. — Jan. 27, 2014 — For patients who have experienced a large stroke that ...
HIV medications dialogue differs by race, ethnicity
2014-01-27
PROVIDENCE, R.I. [Brown University] — A lot of evidence shows that a patients' race or ethnicity is associated with differences in how health care providers communicate with them, the health care they receive, ...
Study identifies high level of 'food insecurity' among college students
2014-01-27
CORVALLIS, Ore. – One of the few studies of its type has found that a startling 59 percent of college students at one Oregon university were "food insecure" at ...
Graphene-like material made of boron a possibility, experiments suggest
2014-01-27
PROVIDENCE, R.I. [Brown University] — Researchers from Brown University have shown experimentally that a boron-based competitor to graphene is a very real possibility.
Graphene has been heralded ...
Drug to reverse breast cancer spread in development
2014-01-27
Researchers at Cardiff University are developing a novel compound known to reverse the spread of malignant breast cancer ...
Blue eyes and dark skin, that's how the European hunter-gatherer looked
2014-01-27
La Braña 1, name used to baptize a 7,000 years ...
Engineers teach old chemical new tricks to make cleaner fuels, fertilizers
2014-01-27
University researchers from two continents ...
Sensitivity of carbon cycle to tropical temperature variations has doubled, research shows
2014-01-27
The tropical carbon cycle has become ...
Cleveland Clinic researchers discover process that turns 'good cholesterol' bad
2014-01-27
Cleveland: Cleveland Clinic researchers have discovered the process by ...
Shortening guide RNA markedly improves specificity of CRISPR-Cas nucleases
2014-01-27
A simple adjustment to a powerful gene-editing tool may be able to improve its specificity. In a report receiving advance online publication in Nature Biotechnology, Massachusetts ...
LAST 30 PRESS RELEASES:
Chungnam National University researchers reveal how vitamin D is shown to reduce liver damage by boosting TXNIP activity in cholangiocytes
The key to success: Why university startups don’t perform as well as corporate startups
Muscle “marbling”: Good in steak, bad in our bodies
Thousands more B.C. women chose top-tier birth control after patient costs eliminated
Research reveals genetic weak spot in hard-to-treat cancers
Coolness hits different; now scientists know why
Large-scale study defines genetic architecture of stuttering
Decoding the blue: Advanced Technology realizes potential in harmful algal bloom monitoring
How plants are learning to spot sneaky bacterial invaders
One in 11 older Canadians has experienced depression, University of Toronto study finds
VR nature scenes reduce sensitivity to pain – especially for those who feel present during the experience
Canadian health data security is critical in changing political climate
Helping Canada lead in health innovation
Virtual care network for rural and First Nations communities
Dementia takes 3.5 years to diagnose after symptoms begin
Robotic space rovers keep getting stuck. UW engineers have figured out why
New research shows how immigration status can become a death sentence during public health crisis
University of Toronto Engineering researchers develop safer alternative non-stick coating
Good vibrations: Scientists use imaging technology to visualize heat
More ecological diversity means better nutritional resources in Fiji’s agroforests
New global study shows freshwater is disappearing at alarming rates
Scientists create an artificial cell capable of navigating its environment using chemistry alone
A little salt is good for battery health
Deep-sea fish confirmed as a significant source of ocean carbonate
How to keep kids with eating disorders home after hospital stay? Therapy
Sex differences affect efficacy of opioid overdose treatment
Aligning AI with Human Values and Well-Being
Engineering the next generation of experimental physics
The scuba diving industry is funding marine ecosystem conservation and employing locals
BATMAN brings TCR therapy out of the shadows
[Press-News.org] Good outcomes with staged surgery for epilepsy in children2-step approach allows localization and resection in complex cases, reports Neurosurgery