LINEAR GROWTH AFTER CORTICAL RESECTION OR CALLOSOTOMY IN CHILDREN WITH REFRACTORY EPILEPSY
Cukiert A, Burattini JA, Mariani PP, Camara RB, Seda L, Baldauf CM, Argentoni-Baldochi M, Baise-Zung C, Forster CR, Mello VA.
Department of Neurology and Neurosurgery, Epilepsy Surgery Program, Hospital Brigadeiro and Clinica de Epilepsia de Sao Paulo, Sao Paulo SP, Brazil.
Children with refractory epilepsy often present with delayed growth. We studied the effect of epilepsy surgery on linear growth of kids with refractory focal or generalized epilepsy.
Eleven consecutive children with refractory epilepsy were evaluated as for their linear growth after epilepsy surgery. Six kids were submitted to focal cortical resection and five to extensive callosal section (90%). Age ranged from 3 months to 8 years (mean=4.1 years). All patients had daily seizures. Four children had cortical dysplasia on MRI, two had gliotic lesions and five diffuse atrophy (those submitted to callosal section). Antiepileptic medications were kept at the same regimen as preoperatively, at least for one postoperative year. Follow up time ranged from 1.1 to 5 years (mean=1.8 years).
Preoperatively, one patient was growing under the 2.5 growth percentile, 8 within the 2.5 and 10 percentile and one within the 10 and 25 percentile intervals. All patients submitted to cortical resection have been rendered seizure-free after surgery; all kids submitted to callosal section had a 90% decrease of the generalized seizure frequency, but none was seizure-free. All patients improved their linear growth after surgery and all of them were growing at least two percentile intervals above the preoperative level. Although not statistically significant, this “catch-up” phenomenon was clinically more noticeable in those kids submitted to callosal section.
Children with refractory epilepsy that underwent successful epilepsy surgery caught-up with linear growth after surgery. Although this could be seen as recovery from a chronic illness in the kids with focal resections that were seizure-free postoperatively, it is unlikely that an isolated response to improved health would be responsible for the additional growth in patients submitted to callosal section, who were not seizure-free postoperatively. In this pediatric population, an inhibitory effect on growth from the epileptic activity might explain this postoperative catch-up phenomenon, especially in children with generalized epilepsy.