Nonpharmacologic Treatments for Epilepsy-Epilepsy Surgery in Infants and Young Children

Video Transcription

My name is Rohini Kaur, and I'm the chair of the SIG. I am joined by our vice chair, Jorian Peters. Our incoming vice chair, Itai Bushlin, was unable to make it today.  These are our disclosures. And these are our learning objectives. I think you'll be very excited to hear what the speakers have in store today.  So we have many seizure medications, nearly 30. And we are far from perfect from our treatment with epilepsy with medicine, with nearly a third  of our epilepsy patients medically refractory. So relatively recent advances over the years have led to an increased utilization in epilepsy  surgery for individuals with refractory epilepsy. This is across the adult and pediatrics group. So the National Association for Epilepsy Centers  published data showing an increase in level 3 and 4 epilepsy centers between 2012 and 2019, from 161 to 256 centers. And as you can see where the red line is, the pediatric only  centers grew from 22 centers in 2012 to 50 accredited centers in 2019. And so what does this mean, more surgery? So surgeries experiencing the most growth  were laser interstitial thermotherapy, responsive neurostimulation, intracranial monitoring, and other surgeries decreased, including VNS corpus callosotomy.  Could be that we recognize surgery in more complex cases and we have more diagnostic tools. But this is for all individuals with epilepsy. So what about the youngest patients?  The very young, including infants and toddlers, have unique characteristics that makes generalizing what we know about localizing seizures and operating on this age group difficult.  Common reasons are semiology, development, anatomy, the potential for multiple active areas bilaterally, and very small size. These may give us pause.  However, the advances I mentioned apply to this group also. You will see how SEEG, Advanced Imaging Techniques in Early Surgical Treatment, can be safely  applied to lessen the impact of seizures in the developing brain.

Video Summary

Rohini Kaur, chair of the SIG, discussed advancements in epilepsy treatment, noting that nearly a third of epilepsy patients remain medically refractory. Recent progress has increased the utilization of epilepsy surgeries, particularly for refractory cases, with National Association for Epilepsy Centers data showing growth in accredited centers between 2012 and 2019. Surgeries like laser interstitial thermotherapy and responsive neurostimulation have increased, while others have decreased. Infant and toddler patients present unique challenges due to developmental factors, but advances like SEEG and advanced imaging can help safely reduce seizure impact on their developing brains.

Asset Subtitle

Presenter:

Dr. Rohini Coorg is an Assistant Professor in the department of Pediatrics, Division of Child Neurology at Baylor College of Medicine/Texas Children's Hospital. She is board certified in child neurology, neurophysiology and epilepsy and specialize in the surgical management of refractory epilepsy in pediatric patients, particularly those affected by Tuberous Sclerosis Complex.

Keywords

epilepsy treatment

refractory epilepsy

epilepsy surgery

SEEG

advanced imaging