Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience

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dc.contributor.advisorEnslin, Johannes
dc.contributor.advisorWilmshurst Joanne
dc.contributor.advisorFieggen, A G
dc.contributor.authorLouw, Lizet
dc.date.accessioned2023-07-03T08:18:22Z
dc.date.available2023-07-03T08:18:22Z
dc.date.issued2023
dc.date.updated2023-07-03T08:17:35Z
dc.description.abstractPurpose While epilepsy surgery has been shown to reduce seizure frequency and severity and even cures seizures in children with drug-resistant epilepsy, data from middle-income countries (MIC) are lacking. Method This study is a retrospective review of children with drug-resistant epilepsy who underwent surgical treatment at Red Cross War Memorial Children's Hospital (RCWMCH) between 1 January 2000 and 31 December 2021 (HREC: 140/2020). Results During the 21-year study period, 60 patients underwent epilepsy surgery for drugresistant epilepsy. The median age of the children was seven years (IQR 4.81-10.27years) at the time of surgery, with a male predominance of 33 patients. The most common surgical procedure performed was an anterior temporal lobectomy for temporal lobe epilepsy in 19 cases (31.7%), followed by peri-insular hemispherotomy in 9 cases (15.0%) and frontal lobectomy in 8 cases (13.3%). Of the 60 patients, complete records were available for 55 patients noting complications in 11 (20.0%), of which 4 cases (7.3%) had major complications. Notably, 2 patients (3.6%) had new-onset psychiatric symptoms. The long term outcomes after surgery showed 1-year seizure freedom in 32 patients (58.2%); among these, 21 patients (38.2%) could stop ASM one year after surgery, 17 patients (30.9%) had a recurrence of their seizures, and three had to restart ASM after 2-3 years. Eight patients (14.5%) required repeat surgery. The one-year-Modified Engel scoring for the study population was: 1-A in 52.7%, I-B in 3.6%, I-C in 1.8%, II-A in 15.8%, III-A in 10.9%, IV-A in 3.6% and IV-B in 10.9%. The most common histological finding in anterior temporal lobectomy (ATL) was focal cortical dysplasia (FCD), found in 11 patients (57.9%). The periinsular hemispherotomy (PIH) cases had equal numbers of FCD and Rasmussen's encephalitis in 4 patients (44.4%). The number of FCD in this series is much higher than in international data. Conclusion Epilepsy surgery is an effective and attainable intervention for drug-resistant epilepsy in the paediatric population despite limited resources and challenging aetiological profiles. Low complication rates were comparable to international data, with good seizure freedom outcomes.
dc.identifier.apacitationLouw, L. (2023). <i>Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience</i>. (). ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/38002en_ZA
dc.identifier.chicagocitationLouw, Lizet. <i>"Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience."</i> ., ,Faculty of Health Sciences ,Division of General Surgery, 2023. http://hdl.handle.net/11427/38002en_ZA
dc.identifier.citationLouw, L. 2023. Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience. . ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/38002en_ZA
dc.identifier.ris TY - Master Thesis AU - Louw, Lizet AB - Purpose While epilepsy surgery has been shown to reduce seizure frequency and severity and even cures seizures in children with drug-resistant epilepsy, data from middle-income countries (MIC) are lacking. Method This study is a retrospective review of children with drug-resistant epilepsy who underwent surgical treatment at Red Cross War Memorial Children's Hospital (RCWMCH) between 1 January 2000 and 31 December 2021 (HREC: 140/2020). Results During the 21-year study period, 60 patients underwent epilepsy surgery for drugresistant epilepsy. The median age of the children was seven years (IQR 4.81-10.27years) at the time of surgery, with a male predominance of 33 patients. The most common surgical procedure performed was an anterior temporal lobectomy for temporal lobe epilepsy in 19 cases (31.7%), followed by peri-insular hemispherotomy in 9 cases (15.0%) and frontal lobectomy in 8 cases (13.3%). Of the 60 patients, complete records were available for 55 patients noting complications in 11 (20.0%), of which 4 cases (7.3%) had major complications. Notably, 2 patients (3.6%) had new-onset psychiatric symptoms. The long term outcomes after surgery showed 1-year seizure freedom in 32 patients (58.2%); among these, 21 patients (38.2%) could stop ASM one year after surgery, 17 patients (30.9%) had a recurrence of their seizures, and three had to restart ASM after 2-3 years. Eight patients (14.5%) required repeat surgery. The one-year-Modified Engel scoring for the study population was: 1-A in 52.7%, I-B in 3.6%, I-C in 1.8%, II-A in 15.8%, III-A in 10.9%, IV-A in 3.6% and IV-B in 10.9%. The most common histological finding in anterior temporal lobectomy (ATL) was focal cortical dysplasia (FCD), found in 11 patients (57.9%). The periinsular hemispherotomy (PIH) cases had equal numbers of FCD and Rasmussen's encephalitis in 4 patients (44.4%). The number of FCD in this series is much higher than in international data. Conclusion Epilepsy surgery is an effective and attainable intervention for drug-resistant epilepsy in the paediatric population despite limited resources and challenging aetiological profiles. Low complication rates were comparable to international data, with good seizure freedom outcomes. DA - 2023 DB - OpenUCT DP - University of Cape Town KW - Epilepsy surgery KW - children KW - drug-resistant epilepsy KW - low- and middle-income countries KW - complications LK - https://open.uct.ac.za PY - 2023 T1 - Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience TI - Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience UR - http://hdl.handle.net/11427/38002 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/38002
dc.identifier.vancouvercitationLouw L. Paediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience. []. ,Faculty of Health Sciences ,Division of General Surgery, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/38002en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of General Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.subjectEpilepsy surgery
dc.subjectchildren
dc.subjectdrug-resistant epilepsy
dc.subjectlow- and middle-income countries
dc.subjectcomplications
dc.titlePaediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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