Outcome of Epilepsy Surgery in

Children in Semarang, Central Java,

Indonesia
Indra Jaya, Alifiani Hikmah
Putranti, M.Thohar Arifin,
Zainal Muttaqin
Dr. Kariadi General
Hospital, Semarang,
Indonesia

Introduction 1
Epilepsy surgery : indicated
for patients with medically
refractory epilepsy.
Children with epilepsy :
10 - 40% medically refractory
epilepsy Surgery

Introduction 2
Medically refractory
epilepsy:
seizures that are not controlled after
an adequate trial with 2 first-line
AEDs.
International League Against
Epilepsy :
a failure of adequate trials of two
tolerated and appropriately chosen
and used AED schedules (whether as
monotherapies or in combination) to
achieve a sustainable free of
seizure

Introduction 3
Advances
in
neuroimaging technologies,
more than 50% of patients
with refractory epilepsy
epilepsy surgery

Objective
To assess the outcome of epilepsy
surgery in children.

Method

Retrospective study between January

2000 and March 2012
Subjects :
32 children with epilepsy
age: 2-16 years at surgery
at least 4 months post-surgery followup

RESULT
Table 1. Characteristics of subjects
Characteristics
Age at surgery (years)
Age at onset (years)
Follow up (month)

Mean
12.9
6.4
60.6

Table 2. Characteristics of subjects

Characteristics
Sex
Male
Female
Seizure frequency before surgery
< 5 attacks monthly
5 10 attacks monthly
> 10 attacks monthly
Type seizure :
GTCS
CPS
Others
Neuroimaging abnormality :
mesial temporal sclerosis

Percentage (%)

50
50
59.4
3.1
37.5
6.3
78.1
15.6
81.25
62.5

Chart Title

lesionectomy; 6%

callosotomy; 10%

ATL with Lesionectomy; 3%

ATL; 81%

Fig . 1. Types of surgery

Table 2. : Postsurgical outcome

Outcome

Seizure free :

anti-epileptic
drugs (AED)
discontinuation

Percentage (%)
81.3
56.25
0

postoperative
mortality

Chart Title

4AEDs; 9%
1AED; 28%
3AEDs; 35%
2AEDs; 28%

Fig 2 : Post surgical AEDs among Free Seizure

Children

Outcome
After epilepsy surgeries :
Seizure free : 26 (81,3%) children
Discontinuation of an anti-epileptic
drugs (AED) : 18 (56.25%) children
No postoperative mortality

Discussion

Tisi JD, 2010 used survival methods 52% of patients remained

seizure free at 5 years after surgery, and 47% (4251) at 10 years.
Jayalakshmi S et al, 2011 have studied indicates that surgery is a
valuable option to treat children with drug-resistant focal epilepsies,
with 75.6% being free of disabling seizures
Our study :
seizure free outcome was noted in 81,3%,
56.25% children have discontinuation of anti-epileptic drugs
(AED)
The MRI brain was mesial temporal sclerosis in 20 (62.5%)

Conclusion
Favourable outcome after epilepsy
surgery can be obtained in children
with medically refracter epilepsy.
Epilepsy surgery is an effective
and safe therapeutic modality in
children with epilepsy

SUGGESTION
Should be measured other outcomes :
developmental and cognitive,
behavioral and psychosocial,
improvement in health-related quality of life
(HRQOL).

THANK YOU

ILAE classification system

Classification Completely seizure free; no auras
Outcome
Click
to
add text
1
Only auras; no other seizures
Outcome classification
2
Outcome classification
3
Outcome classification
4
Outcome classification
5
Outcome classification
6

1 to 3 seizure days per year; auras

4 seizure days per year to 50%
reduction of baseline seizure days;
auras
Less than 50% reduction of baseline
seizure days; auras
More than 100% increase of baseline
seizure days; auras