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Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing?

Hale, Andrew T; Chari, Aswin; Scott, Rod C; Cross, J Helen; Rozzelle, Curtis J; Blount, Jeffrey P; Tisdall, Martin M; (2022) Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing? Brain , 145 (11) pp. 3755-3762. 10.1093/brain/awac275. Green open access

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Abstract

Epilepsy surgery is an established safe and effective treatment for selected candidates with drug-resistant epilepsy. In this opinion piece, we outline the clinical and experimental evidence for selectively considering epilepsy surgery prior to drug resistance. Our rationale for expedited surgery is based on the observations that, 1) a high proportion of patients with lesional epilepsies (e.g. focal cortical dysplasia, epilepsy associated tumours) will progress to drug-resistance, 2) surgical treatment of these lesions, especially in non-eloquent areas of brain, is safe, and 3) earlier surgery may be associated with better seizure outcomes. Potential benefits beyond seizure reduction or elimination include less exposure to anti-seizure medications (ASM), which may lead to improved developmental trajectories in children and optimize long-term neurocognitive outcomes and quality of life. Further, there exists emerging experimental evidence that brain network dysfunction exists at the onset of epilepsy, where continuing dysfunctional activity could exacerbate network perturbations. This in turn could lead to expanded seizure foci and contribution to the comorbidities associated with epilepsy. Taken together, we rationalize that epilepsy surgery, in carefully selected cases, may be considered prior to drug resistance. Lastly, we outline the path forward, including the challenges associated with developing the evidence base and implementing this paradigm into clinical care.

Type: Article
Title: Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing?
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/brain/awac275
Publisher version: http://doi.org/10.1093/brain/awac275
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: epilepsy, epilepsy surgery, focal cortical dysplasia, long-term epilepsy associated tumours, paediatric
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10153615
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