Surgical Outcomes for Medically Resistant Epilepsy

When surgical treatment is indicated for children and infants with medically resistant epilepsy (seizures that cannot be curbed by prescription medications), the Comprehensive Epilepsy Program at Nicklaus Children's Hospital stands out as one of the centers with over 1,300 surgeries performed since 1985 for epilepsy in children.

Established in 1985 and part of the renowned Nicklaus Children's Brain Institute, the center has the longest patient follow up of any epilepsy center in the state.

Currently, there are no national benchmarks for outcomes for pediatric epilepsy surgery. Nicklaus Children's is an advocate for benchmarking to ensure a high standard of care throughout the world.

Medical First and Major Accomplishments

  • Successfully separated conjoined twins who had a fused spinal cord without leaving significant neurologic deficits in either child. 
  • First to implant intracranial electrodes in children to locate seizure foci and MRI-Guided Laser Ablation Surgeryguide seizure surgery. 
  • First to perform endoscopic resection of PTEN Hamartoma Tumor Syndromehypothalamic hamartomas. 
  • Has performed more successful epilepsy surgeries on children with normal MRI scans than any other program in the nation.
  • Has performed one of the largest number of successful of brachial plexus reconstructions in children in the nation. 
  • Most experienced in the state in performing difficult brain and Spinal Cord Tumorsspinal cord tumor surgeries. 

Excellent Outcomes for Patients

The chart below shows that the benefits of surgery remain steady for over a decade, potentially leading to a long-term impact on quality of life, education, social and employment status. Even ten years after surgery, 67 percent of patients were almost entirely seizure-free.

percentage of patients free of seizures over a 10 year span

Least Invasive Surgical Approach

The Comprehensive Epilepsy Center is recognized for an approach that focuses on removing the least amount of brain tissue possible while maximizing the reduction in seizure activity.

The primary aim of this "less is more" philosophy is to achieve seizure control while preserving movement, language, memory, vision, and other eloquent functions in the patient. As the chart below shows, most of our children have undergone small or focal resections, with only a fraction undergoing the more invasive removal of a hemisphere (less than 5 percent of patients).

Types of surgeries chart

Minimal Resections Compared to Other Global Centers

To put this in perspective, we compared the size of our resections with 20 other leading pediatric epilepsy surgery centers worldwide. The chart below presents data obtained through an ILAE survey and published in 2005. This chart highlights our program's emphasis on small "unilobar" surgeries that help minimize functional deficits. Our outcomes are as good or better than other centers performing larger resections. 

resection surgeries comparison chart

Low Rates of Complications

When possible, our team also uses minimally invasive surgical options that further minimize risk and offer greater comfort and speedier recoveries. The resulting low rates of complications over a five year span are highlighted in the chart below.

percentage of surgical complications over 5 years

Efficient Surgeries Result in Reduced Multistage Operations

Our child-centered “less is more” approach also extends to minimizing the number of invasive procedures. We are a highly specialized and experienced center with the capacity of performing multistage surgeries. Our comprehensive, multidisciplinary team optimizes sophisticated pre-operative assessments prior to patient selection for implantation, and meticulous monitoring and evaluation during implantation. This leads to an extremely high 95 percent rate of second stage resection after implantation, which compares very favorably to the 50 to 60 percent resection rates reported by some of the leading national centers.

implant surgeries comparison chart