Neurosurgical management of childhood-onset epilepsy in periventricular nodular heterotopia: A systematic review of effectiveness and outcomes.
Srishruthi Thirumalai, Dimitrios Champsas, Manuela Lo Bianco et al.
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In 30 seconds
This systematic review evaluated neurosurgical interventions for childhood-onset epilepsy associated with periventricular nodular heterotopia (PVNH) across 30 studies involving 134 patients. The review found that 50.7% achieved excellent outcomes, defined as seizure freedom or auras only, and 76.9% experienced meaningful benefit with at least a 50% reduction in seizure frequency. Outcomes were significantly better for unilateral PVNH compared to bilateral.
Key findings
- 50.7% of patients achieved excellent outcomes, defined as seizure freedom or auras only.
- 76.9% experienced meaningful benefit with at least a 50% reduction in seizure frequency.
- Outcomes were better in unilateral PVNH (75.9%) than bilateral (33.8%, p < 0.001).
- Permanent morbidity was observed in 10.4% of patients, primarily visual field deficits.
Why it matters
Understanding the effectiveness of surgical interventions for childhood-onset epilepsy in PVNH can guide treatment decisions, particularly in refractory cases. The findings highlight the importance of lesion laterality and complete nodule removal in improving outcomes.
What to keep in mind
The review is limited by the retrospective nature of the included studies and small sample sizes, indicating a need for more robust prospective multicentre data.