Clinical characteristics and predictors of seizure recurrence in children and adults undergoing frontal lobe epilepsy surgery: A comparative study.
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Frontal lobe epilepsy (FLE) is the second most common surgically treated focal epilepsy. Our study aims to compare the clinical characteristics, seizure outcomes, and their predictors between pediatric (<18 years) and adult patients undergoing FLE surgery. Clinical data from consecutive pediatric and adult patients with FLE were retrospectively analyzed and compared at a tertiary hospital. Univariate and multivariate analyses were used to identify the predictors of seizure recurrence. A total of 234 patients with FLE (67 children) were included. Of them, 61.1 % (143/234) achieved Engel I outcomes. The probability of ≥ 4 seizures/month, ≥3 types of anti-seizure medications (ASMs) at the time of surgery, concordant interictal EEG, positron emission tomography performed, intracranial monitoring, surgical procedure for frontal lobe disconnection or plus anterior callosotomy, and pathology as malformations of cortical development (MCD) was significantly higher in the pediatric group than in the adult group. By contrast, the probability of positive MRI, normal interictal EEG, previous cranial surgery, and pathology as tumors and gliosis was significantly higher in the adult group than in the pediatric group. However, the probabilities of complications, acute postoperative seizures (APOS), Engel I outcomes, and being free of ASMs did not differ between the groups. Univariate and multivariate analyses demonstrated that using of ≥ 3 types of ASMs (OR 0.298, 95 % CI 0.089-0.998, p = 0.050) and previous cranial surgery (OR 0.062, 95 % CI 0.007-0.528, p = 0.011) predicted seizure recurrence in the pediatric group. Contrarily, only epilepsy duration (OR 0.948, 95 % CI 0.900-1.000, p = 0.048) predicted seizure recurrence in the adult group. The clinical features and predictors of seizure recurrence significantly differ between pediatric and adult patients with FLE, which should be used for individualized preoperative counseling for patients of different ages.