SEATTLE—Resective epilepsy surgery may be an effective treatment option for certain children with Lennox–Gastaut syndrome secondary to early focal brain lesion or injury, according to findings presented at the 68th Annual Meeting of the American Epilepsy Society.
Ahsan Moosa Naduvil, MD, neurologist at the Cleveland Clinic Epilepsy Center, and colleagues studied 36 patients with Lennox–Gastaut syndrome who underwent epilepsy surgery at the Cleveland Clinic for focal, lobar, or multilobar resection or hemispherectomy between June 1, 2002 and June 31, 2012.
All participants had developed epilepsy as a result of brain lesions or injuries. Of the 36 patients, 17 sustained injury before they were born, 10 sustained injury immediately before or after they were born, and nine sustained injury between ages 2 months and 3 years. At the time of surgery, the patients ranged in age from newborn to 18 years and were experiencing multiple seizures per day.
When the investigators conducted follow-up visits at six months to 6.6 years after surgery, they observed that 19 patients were seizure-free. Of the patients who still were having seizures, two had late remission at two years after surgery, and five became almost seizure-free, with an average of nine seizures per month. At the last follow-up visit, 24 patients were either seizure-free or had experienced a major reduction in seizure frequency.
“In the past, children with features of Lennox–Gastaut syndrome were not considered to be candidates for epilepsy surgery that involves removal of the seizure focus,” said Dr. Naduvil. “Our study confirms that selected children with early brain lesions may be rendered seizure-free with epilepsy surgery.”
The authors performed a survival analysis based on the duration of time between seizures. They calculated the chance of seizure freedom as 60.1% at 12 months, 51% at 24 months, and 40.8% at 30 months or more.
“Most of the patients with Lennox–Gastaut syndrome are not candidates for curative surgery, but there is a small subset—especially the ones with an MR abnormality, especially the ones with a one-sided brain abnormality. They may be candidates for epilepsy surgery,” said Dr. Naduvil. Before a neurologist considers palliative surgery for a patient with Lennox–Gastaut syndrome who is not responding to medications, he or she should evaluate the patient for a curative surgery, he concluded.