Approximately one-third of children with epilepsy do not respond to medication, and a proportion of these children may be considered for surgery to remove the part of the brain where their seizures originate.
Before surgery, a neurosurgeon needs to obtain an accurate image of the child’s brain and the areas in which important functions (such as language) reside, to avoid removing or damaging them during the operation. This is achieved using imaging and neuropsychological testing. However, children’s seizures often originate in one of these critical brain regions, and this makes the decision of whether or not to operate even more difficult.
Epilepsy Research UK funded Professor Torsten Baldeweg and his team at University College London (UCL) who investigated the long-term impact of epilepsy surgery in children. Professor Baldeweg used state of the art neuroimaging techniques, as well as language and neuropsychological tests. They demonstrated that children who had surgery had fewer seizures and better language and neuropsychological results than children who did not have surgery. They also revealed that the majority of children who were seizure free after surgery showed significant increases in brain volume and improved cognitive scores.
Based on the patient data generated through this research, doctors can now make better predictions of cognitive outcomes for children following surgery. These results have also helped make the case for earlier detection and surgical treatment in children for whom surgery is an option.
Professor Baldeweg said: “These studies are unique, in that we have been able to follow patients for up to 15 years after surgery, being able to chart their cognitive and educational trajectory during this important part of their lives.
The grants have enabled us to conduct a major study which is vital for the field of paediatric epilepsy surgery. This has also provided an important benchmark for the evaluation of non-invasive neuroimaging methods. Without EUK funding, this study would not have been possible. We are immensely grateful for ERUK and its supporters for this support.
Building on the results of their ERUK funding projects, the research team are currently conducting a 20-year review and follow up of over 1,000 children who had neurosurgical treatment for their epilepsy at Great Ormond Street Hospital since 2000. The aim is to better predict who will benefit from neurosurgery in terms of seizure freedom and to establish the longer-term impact of epilepsy surgery on cognition.
Rachel is one of many young people who, thanks to this ground-breaking research, is now seizure free and has achieved a life free from epilepsy. In February 2010, eight-year-old Rachel underwent surgery to remove a piece of tissue the size of a 20 pence piece from her brain. The family saw a dramatic instant transformation in Rachel. With the help of medication, speech therapy and a child psychologist, Rachel made a full recovery and has had no seizures since.
You can read Rachel’s story here.