Surgical treatment of MRI-negative drug resistant epilepsy in children

Abstract

Objective: analysis of treatment tactics for patients with magnetic-resonance-imaging (MRI) negative epilepsy, characteristics of morphological data and assessment of the treatment results.Material and methods. Within the period of 2013–2021, 31 patients under the age of 18 with drug-resistant nonlesional epilepsy were examined according to the “epilepsy” MRI-protocol. Patient distribution by gender, age, duration of illness, age of onset, number of anticonvulsant protocols, frequency of seizures at the time of initiated treatment, side and lobe of the seizure generation zone was analyzed. The instrumental diagnostic methods were noted in a specially designed study form and reported contribution of relevant result to epileptogenic zone. The distribution of patients according to surgical intervention and histological data was also analyzed.Results. Resection surgery was carried out in 26 (83.9%) patients. Palliative operations were performed in 5 (16.1%) cases with bilateral localization of the epileptic focus: callosotomy (3) and vagal nerve stimulation (2). Twelve months post-therapy outcomes by Engel class I were found in 19 (61.3%) patients, class II – in 6 (19.4%), class III – in 5 (16.1%), and class IV – in 1 (3.2%). Long-term results of surgical treatment were assessed 3 and 5 years later.Conclusion. Surgery of MRI-negative epilepsy can be effective with seizure-free outcome in 61.3% of cases, but requires use of additional diagnostic methods in relation to standard pre-surgery examination to localize epileptogenic zone.

Keywords

• pharmacoresistant epilepsy
• children
• magnetic resonance imaging
• mri
• mri-negative epilepsy
• surgery for epilepsy
• seizures
• outcome of surgery