Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing?
| العنوان: | Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing? |
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| المؤلفون: | Andrew T Hale, Aswin Chari, Rod C Scott, J Helen Cross, Curtis J Rozzelle, Jeffrey P Blount, Martin M Tisdall |
| المصدر: | Brain. 145:3755-3762 |
| بيانات النشر: | Oxford University Press (OUP), 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Drug Resistant Epilepsy, Brain Diseases, Epilepsy, Treatment Outcome, Seizures, Quality of Life, Drug Resistance, Humans, Neurology (clinical), Child, Retrospective Studies |
| الوصف: | Epilepsy surgery is an established safe and effective treatment for selected candidates with drug-resistant epilepsy. In this opinion piece, we outline the clinical and experimental evidence for selectively considering epilepsy surgery prior to drug resistance. Our rationale for expedited surgery is based on the observations that (i) a high proportion of patients with lesional epilepsies (e.g. focal cortical dysplasia, epilepsy-associated tumours) will progress to drug resistance; (ii) surgical treatment of these lesions, especially in non-eloquent areas of brain, is safe; and (iii) earlier surgery may be associated with better seizure outcomes. Potential benefits beyond seizure reduction or elimination include less exposure to antiseizure medications, which may lead to improved developmental trajectories in children and optimize long-term neurocognitive outcomes and quality of life. Further, there exists emerging experimental evidence that brain network dysfunction exists at the onset of epilepsy, where continuing dysfunctional activity could exacerbate network perturbations. This in turn could lead to expanded seizure foci and contribution to the comorbidities associated with epilepsy. Taken together, we rationalize that epilepsy surgery, in carefully selected cases, may be considered prior to drug resistance. Last, we outline the path forward, including the challenges associated with developing the evidence base and implementing this paradigm into clinical care. |
| تدمد: | 1460-2156 0006-8950 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ec86acf7f0f2f12d13364a75ea91c98fTest https://doi.org/10.1093/brain/awac275Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....ec86acf7f0f2f12d13364a75ea91c98f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14602156 00068950 |
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