Surgical precision treatment of children with epilepsy 6 years after surgery

Jia jia (pseudonym) came back for follow-up consultation, after receiving epilepsy surgery in the epilepsy surgery center of Sanbo Brain Hospital of Capital Medical University for 6 years, preoperative seizures had more than 20 seizures per day, and there was no seizure once in 6 years after the operation, and the ideal degree of EEG recovery made Jiajia's chief surgeon, Guan Yuguang, director of functional neurosurgery and director of surgery of Epilepsy Center, capital Medical University Sanbo Brain Hospital, very pleased.

The drug can not be controlled Up to 20 seizures a day

Jiajia, a 15-year-old child with epilepsy, 9 years ago, after being frightened, she had a nose sucking and blinking movement, mostly when she was awake, and had 4-5 seizures a day. At first, the family didn't pay much attention. In 2013, due to the stimulation of the death of a loved one, Jiajia's seizures became more severe, manifesting in another form, with both eyes squinting to the left and the head and body turning to the left, accompanied by loss of consciousness. After visiting the local hospital, the local hospital diagnosed "epilepsy", and after several drugs were prescribed, the epilepsy still had seizures. After taking the drug for 3 months, Jiajia's seizures became more serious, and the frequency of attacks also increased suddenly, which was manifested by falls, loss of consciousness, rigidity of limbs, eyes turned up, and screaming gradually eased, with a maximum of more than 20 seizures a day.

Since then, jiajia family has embarked on a long road to seek medical treatment, to a number of hospitals to check a number of, but the cause has not been clear, medication control of the condition has not improved, the number of seizures has become more and more frequent, Jiajia is extremely depressed, memory is obviously reduced, temper is much more grumpy than before, can only rest at home, and even dare not go out.

After inquiring from many parties, I learned that Guan Yuguang, director of the Department of Functional Neurosurgery and director of surgery of the Epilepsy Center of Sanbo Brain Hospital of Capital Medical University, has a reputation for the diagnosis and treatment of refractory epilepsy in children. In 2016, with the last hope, Jiajia's family came to Beijing to find Director Guan Yuguang.

Surgery to remove epilepsy root No seizures for 6 years after surgery

After admission, Director Guan Yuguang arranged to improve various admission routine examinations, head epilepsy series of MRI examinations, long-distance video EEG, magnetoencephalogram, etc. Cranial MRI display: right frontal abnormal signal, video EEG detection as a continuous slow wave, diffuse, bilateral anterior head is particularly obvious, spontaneous magnetic field acquisition during magnetic field monitoring can see a moderate number of epileptic-like discharge, visible around the right lateral fissure.

Guan Yuguang combined with the patient's medical history, according to the examination results, multiple consultations, and finally diagnosed refractory and secondary epilepsy, considered focal cerebral cortical dysplasia, with clear indications for surgery.

Director Guan Yuguang said that from the examination results, focal cerebral cortical dysplasia is the root cause of Jiajia's epilepsy. Focal cortical dysplasia is a common type of cortical dysplasia and one of the most common causes of epilepsy. If epilepsy is clearly caused by focal cortical dysplasia, especially some imaging abnormalities, such patients are generally drug-refractory epilepsy, and surgery can be considered as soon as possible. Early surgery can reduce seizures and reduce the impact of epilepsy on mental and intellectual development.

Director Kwan Woo Kwang is in surgery

With the consent of the family and after a comprehensive assessment, Director Guan Yuguang decided to perform surgical treatment for Jiajia with craniotomy for the right frontotemporal apex and right frontal epileptic focus resection. In order to accurately find the abnormal brain tissue, under the monitoring of neural navigation and intraoperative cortical EEG, according to the abnormal discharge, Director Guan Yuguang and his team accurately located the abnormal discharge area, and after 4 hours and 20 minutes of surgery, the brain tissue with cortical dysplasia was successfully removed. After the operation, Jiajia recovered well, without any functional defects, no more "noisy", and no more seizures. Postoperative pathological return is also focal cortical dysplasia. The doctor instructed Jiajia's parents to bring their children back for follow-up consultations regularly.

In July this year, Jiajia, who had entered junior high school, returned to the hospital for follow-up treatment. Re-examination of the EEG showed no epileptic discharge. At this time, it has been 6 years since Jiajia's surgery. Jiajia did not have a recurrence after the operation, her mental state was very good, her intelligence level also improved significantly, and she went to school normally; Jiajia's family also returned to normal work. Such an ideal ending is really gratifying!

Does early surgery for childhood epilepsy affect brain development?

In the past, the traditional method of treating epilepsy was to let patients take anti-epileptic drugs for more than two years in a regular and sufficient amount, and if the efficacy of the drugs was not satisfactory, the epilepsy control was not good, and then consider surgical treatment according to the condition. About 30% of children still have difficulty controlling seizures after two years of regular drug treatment, and the damage caused by repeated seizures in two years has been difficult to recover. Children's brain and liver and kidney function is not fully developed, long-term anti-epileptic drugs have damage to the child's brain, resulting in cognitive decline, and will damage liver and kidney function, these damages for the child's future growth and development are very unfavorable.

Director Guan Yuguang said that for diagnosed refractory epilepsy, drug treatment can not effectively control the seizures, and those who have a clear location of the epileptic lesion in the brain can be treated surgically after examination. Overall, surgery can allow a significant proportion of these children to have seizures completely controlled or significantly improved.

Some parents are worried about whether early surgery will have a negative impact on their children's brain development. Guan Yuguang introduced that surgery is mainly for refractory epilepsy and secondary epilepsy. After the baby is born, the development of the heart, liver, kidneys and other organs has been basically completed, and with age, the volume increases and there is no continued differentiation and development, only the development of the brain is not completed, the human central nervous system is still developing in the 6-12 months after birth, before or during this period of surgery, after removing a part of the abnormal brain tissue, the brain nerve function can be gradually compensated over time and growth and development; it is also because of this, for this type of surgery should be done as soon as possible, the greater the possibility of nerve function recovery, The later you do it, the more damage the brain will be to the recurrent seizures. In addition, the current various epilepsy surgical methods, using microneurosurgery, neural navigation and other techniques, the trauma is getting smaller and smaller, and the postoperative complications are also less.

Director Guan Yuguang said that for children with refractory epilepsy who are still difficult to control after formal drug treatment, it is necessary to find the cause of recurrent seizures as soon as possible, if imaging examination can find intracranial abnormal lesions, through multimodal neuroimaging, long-range video EEG and stereoSephroscopy and other means to accurately locate the epileptic lesions, the efficacy of early surgical resection is affirmed, and the earlier the timing of surgery, the better. Adjuvant therapy such as vagus nerve stimulation is an option for children with no clear intracranial lesions and difficulty pinpointing the epileptic focus.

Source: Guangming Network