Journal Information
Clinical Research
Uncorrected Proof. Available online 6 August 2025
Epilepsy surgery in children: Outcomes of patients with drug-resistant epilepsy at a paediatric hospital in Bogotá, Colombia, with 10 years of follow-up
Cirugía de epilepsia en los niños: resultados de los pacientes con epilepsia farmacorresistente en un hospital pediátrico de Bogotá, Colombia, durante 10 años de seguimiento
Kevin José Navarro Jaimea, Bryan Gómez Cristanchob, David C. Gómez Cristanchoa,
, Nelson Andres Cuevas Moralesc, Armando Rojas Calderond, Oscar Fernando Zorro Guioe
a Residente de Neurocirugía, Universidad Nacional de Colombia, Bogotá, Colombia
b Médico General, Estudiante de Maestría en Epidemiología Clínica, Universidad del Rosario, Bogotá, Colombia
c Médico General, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
d Neurocirujano, Universidad Nacional de Colombia, Bogotá, Colombia
e Neurocirujano Especialista en Cirugía de Epilepsia y Movimientos Anormales, Estereotaxia, Cirugía Funcional y Radiocirugía, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
Article information
Statistics
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Tables (5)
Table 1. Details of surgical interventions performed.
Tables
Table 2. Postoperative changes in therapeutic approach.
Tables
Table 3. Postoperative outcomes at 1, 3 and 5 years.
Tables
Table 4. Postoperative outcomes according to the type of curative surgery.
Tables
Table 5. Crude relative risks for favourable outcomes at 6 and 12 months of follow-up.
Tables
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Abstract
Introduction

Drug-resistant epilepsy is defined as the lack of response to two appropriately selected antiepileptic drugs that the patient has tolerated properly. Epilepsy is a common neurological disorder in the paediatric population, with an estimated prevalence ranging from 4.3 to 9.3 cases per 1000 children, affecting 1.2% of the global population. Despite pharmacological treatment, between 30% and 40% of patients fail to achieve adequate seizure control, and approximately half of these become candidates for epilepsy surgery.

Objective

To determine the incidence of seizure freedom, considering the Engel classification, in paediatric patients undergoing epilepsy surgery at a level IV paediatric hospital in Bogotá, Colombia.

Methodology

A retrospective observational cohort study was conducted with paediatric patients treated at a level IV paediatric hospital by the epilepsy surgery team between January 1, 2013, and July 31, 2024.

Results

Between 2013 and 2024, a total of 326 patients were evaluated through the epilepsy surgery programme. Of these, 154 underwent surgery. The median postoperative follow-up was 40months. The type of surgery was significantly associated with a higher likelihood of achieving favourable outcomes at 6months (RR=3.54; 95%CI: 1.86–6.77; p<.001) and 12months of follow-up (RR=4; 95%CI: 1.96–8.08; p<.001). The presence of daily seizures and the need for treatment with more than three medications were associated with a lower likelihood of achieving favourable outcomes during the follow-up period.

Conclusions

The loss of years of healthy life since the diagnosis of epilepsy and the type of surgery performed (palliative or curative) were identified as independent factors strongly associated with favourable outcomes in the treatment of drug-resistant epilepsy.

Keywords:
Drug-resistant epilepsy
Epilepsy surgery
Paediatrics
Favourable outcomes
Years of healthy life lost
Resumen
Introducción

La epilepsia farmacorresistente se define como la falta de respuesta a 2 fármacos antiepilépticos seleccionados adecuadamente y que el paciente haya tolerado correctamente. La epilepsia es una enfermedad neurológica común en la población pediátrica, con una prevalencia estimada que varía entre 4,3 y 9,3 casos por cada 1.000 niños, afectando al 1,2% de la población mundial. A pesar del tratamiento farmacológico, entre el 30 y el 40% de los pacientes no logran un control adecuado de las crisis, y aproximadamente la mitad de estos se convierten en candidatos para cirugía de epilepsia.

Objetivo

Determinar la incidencia de libertad de crisis, considerando la clasificación de Engel en los pacientes pediátricos sometidos a cirugía de epilepsia en un hospital pediátrico de IV nivel en la ciudad de Bogotá, Colombia.

Metodología

Se realizó un estudio observacional retrospectivo de cohorte analítica, con pacientes menores de edad tratados en hospital pediátrico de IV nivel por el grupo de cirugía de epilepsia, entre el 1 de enero de 2013 y el 31 de julio de 2024.

Resultados

Entre 2013 y 2024 se evaluaron un total de 326 pacientes a través del programa de cirugía de epilepsia. De estos, 154 fueron sometidos a cirugía. La mediana del seguimiento postoperatorio fue de 40meses. El tipo de cirugía se asoció significativamente con una mayor probabilidad de obtener resultados favorables a los 6meses (RR=3,54; IC 95%: 1,86-6,77; p<0,001) y a los 12meses de seguimiento (RR=4; IC 95%: 1,96-8,08; p<0,001). La presencia de crisis diarias y la necesidad de tratamiento con más de 3 medicamentos se asociaron con una menor probabilidad de lograr resultados favorables durante el seguimiento.

Conclusiones

La pérdida de años de vida saludable desde el diagnóstico de la epilepsia y el tipo de cirugía realizada (paliativa o curativa) fueron identificados como factores independientes fuertemente asociados con resultados favorables en el tratamiento de la epilepsia farmacorresistente.

Palabras clave:
Epilepsia farmacorresistente
Cirugía de epilepsia
Pediatría
Resultados favorables
Años de vida saludable perdidos

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