TRANSITION OF EPILEPSY CARE FROM CHILDREN TO ADULTS
Transition in lesional focal epilepsy, and following epilepsy surgery *J. Helen Cross and †Michael Duchowny Epilepsia, 55(Suppl.3):34–36, 2014 doi: 10.1111/epi.12705
SUMMARY Children with intractable epilepsy benefit from early surgical treatment when possible to reduce long-term morbidity. Issues for transition are variable according to type and timing of surgery, and the outcome. When surgery is successful, cognitive and behavioral improvements may not be apparent for several years. The value of continuing antiepileptic drug (AED) treatment after successful surgery remains unclear, and the adjustment to a life without seizures may be challenging. KEY WORDS: Lesional focal epilepsy, Epilepsy surgery, Temporal lobe epilepsy, Transition, Adulthood. Professor Helen Cross is The Prince of Wales’s Chair of Childhood Epilepsy and Honorary Consultant in Paediatric Neurology at UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, United Kingdom.
Epilepsy characterized by focal seizures, the result of an underlying structural brain abnormality, is associated with significant long-term morbidity. The best model for this is temporal lobe epilepsy (TLE); the Oxford study of children
with TLE followed over a 40-year period demonstrated onethird to be independent off medication, but one third remained independent on medication and a further third remained fully dependent.1 A more recent communitybased study confirmed two thirds of individuals presenting with TLE in childhood to have altered or delayed long-term neurodevelopmental trajectories.2 Ongoing epileptic seizures into adulthood are associated with progressive cognitive impairment,3 and a high risk of psychiatric disorder, particularly when transitioning from adolescence to adulthood.4 The longer the duration of TLE the more likely there will be frontocentral and parietal atrophy.5 Early consideration for resective surgery in carefully selected candidates offers the possibility of an improved long-term outcome.
Accepted May 30, 2014. *UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London & Young Epilepsy, Lingfield, United Kingdom; and †Department of Neurology, Brain Institute, Miami Children’s Hospital, University of Miami Leonard Miller School of Medicine, Miami, Florida, U.S.A. Address correspondence to J. Helen Cross, The Prince of Wale’s Chair of Childhood Epilepsy UCL Institute of Child Health, Great Ormond Street Hospital for Children & Young Epilepsy, 4/5 Long Yard, London WC1N 3LU, U.K. E-mail: [email protected] Wiley Periodicals, Inc. © 2014 International League Against Epilepsy
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35 Transition Following Epilepsy Surgery in Childhood The spectrum of epilepsy surgery in childhood remains wide with regard to procedures and pathologies,6 as well as neurodevelopmental7,8 and neurobehavioral profiles.9,10 The International League Against Epilepsy (ILAE) survey of procedures in 2004 determined that although 60% of surgical candidates had an age of onset of epilepsy of
Transition in lesional focal epilepsy, and following epilepsy surgery *J. Helen Cross and †Michael Duchowny Epilepsia, 55(Suppl.3):34–36, 2014 doi: 10.1111/epi.12705
SUMMARY Children with intractable epilepsy benefit from early surgical treatment when possible to reduce long-term morbidity. Issues for transition are variable according to type and timing of surgery, and the outcome. When surgery is successful, cognitive and behavioral improvements may not be apparent for several years. The value of continuing antiepileptic drug (AED) treatment after successful surgery remains unclear, and the adjustment to a life without seizures may be challenging. KEY WORDS: Lesional focal epilepsy, Epilepsy surgery, Temporal lobe epilepsy, Transition, Adulthood. Professor Helen Cross is The Prince of Wales’s Chair of Childhood Epilepsy and Honorary Consultant in Paediatric Neurology at UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London and Young Epilepsy, Lingfield, United Kingdom.
Epilepsy characterized by focal seizures, the result of an underlying structural brain abnormality, is associated with significant long-term morbidity. The best model for this is temporal lobe epilepsy (TLE); the Oxford study of children
with TLE followed over a 40-year period demonstrated onethird to be independent off medication, but one third remained independent on medication and a further third remained fully dependent.1 A more recent communitybased study confirmed two thirds of individuals presenting with TLE in childhood to have altered or delayed long-term neurodevelopmental trajectories.2 Ongoing epileptic seizures into adulthood are associated with progressive cognitive impairment,3 and a high risk of psychiatric disorder, particularly when transitioning from adolescence to adulthood.4 The longer the duration of TLE the more likely there will be frontocentral and parietal atrophy.5 Early consideration for resective surgery in carefully selected candidates offers the possibility of an improved long-term outcome.
Accepted May 30, 2014. *UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London & Young Epilepsy, Lingfield, United Kingdom; and †Department of Neurology, Brain Institute, Miami Children’s Hospital, University of Miami Leonard Miller School of Medicine, Miami, Florida, U.S.A. Address correspondence to J. Helen Cross, The Prince of Wale’s Chair of Childhood Epilepsy UCL Institute of Child Health, Great Ormond Street Hospital for Children & Young Epilepsy, 4/5 Long Yard, London WC1N 3LU, U.K. E-mail: [email protected] Wiley Periodicals, Inc. © 2014 International League Against Epilepsy
34
35 Transition Following Epilepsy Surgery in Childhood The spectrum of epilepsy surgery in childhood remains wide with regard to procedures and pathologies,6 as well as neurodevelopmental7,8 and neurobehavioral profiles.9,10 The International League Against Epilepsy (ILAE) survey of procedures in 2004 determined that although 60% of surgical candidates had an age of onset of epilepsy of
