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Outcome following multiple subpial transection in Landau-Kleffner syndrome and related regression

Downes, M; Greenaway, R; Clark, M; Helen Cross, J; Jolleff, N; Harkness, W; Kaliakatsos, M; ... Neville, BG; + view all (2015) Outcome following multiple subpial transection in Landau-Kleffner syndrome and related regression. Epilepsia , 56 (11) pp. 1760-1766. 10.1111/epi.13132. Green open access

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Abstract

OBJECTIVE: To determine whether multiple subpial transection in the posterior temporal lobe has an impact on long-term outcome in children who have drug-resistant Landau-Kleffner syndrome (LKS) or other "electrical status epilepticus during sleep" (ESES)-related regression. Given the wide variability in outcomes reported in the literature, a secondary aim was to explore predictors of outcome. METHODS: The current study includes a surgery group (n = 14) comprising patients who underwent multiple subpial transection of the posterior temporal lobe and a nonsurgery comparison group (n = 21) comprising patients who underwent presurgical investigations for the procedure, but who did not undergo surgery. Outcomes were assessed utilizing clinical note review as well as direct assessment and questionnaires. RESULTS: The distribution of nonclassical cases was comparable between groups. There were some differences between the surgery and nonsurgery groups at presurgical investigation including laterality of discharges, level of language impairment, and age; therefore, follow-up analyses focused on change over time and predictors of outcome. There were no statistically significant differences between the groups in language, nonverbal ability, adaptive behavior, or quality of life at follow-up. There was no difference in the proportion of patients showing improvement or deterioration in language category over time for either group. Continuing seizures and an earlier age of onset were most predictive of poorer quality of life at long-term follow-up (F2,23  = 26.2, p = <0.001, R(2)  = 0.714). SIGNIFICANCE: Both surgery and nonsurgery groups had similar proportions of classic LKS and ESES-related regression. Because no significant differences were found in the changes observed from baseline to follow-up between the two groups, it is argued that there is insufficient evidence to suggest that multiple subpial transection provides additional benefits over and above the mixed recovery often seen in LKS and related regressive epilepsies.

Type: Article
Title: Outcome following multiple subpial transection in Landau-Kleffner syndrome and related regression
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/epi.13132
Publisher version: http://dx.doi.org/10.1111/epi.13132
Language: English
Additional information: This is the peer reviewed version of the following article: Downes, M; Greenaway, R; Clark, M; Helen Cross, J; Jolleff, N; Harkness, W; Kaliakatsos, M; (2015) Outcome following multiple subpial transection in Landau-Kleffner syndrome and related regression. Epilepsia , 56 (11) pp. 1760-1766, which has been published in final form at http://dx.doi.org/10.1111/epi.13132. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: Electrical status epilepticus during sleep, Landau-Kleffner syndrome, Multiple subpial transection, Neurocognitive outcome, Neurosurgery
UCL classification: UCL
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
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/1471533
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