Epilepsy Surgery in Children with Intractable Partial Epilepsies

Hwang, Hee; Kwon, Young Se; Lee, Jong Hwa; Lee, Ran; Chae, Jong Hee; Kim, Ki Joong; Hwang, Yong Seung; Cho, Byung Kyu

Abstract

PURPOSE: Few studies have been performed on the value and efficacy of presurgical evaluation methods, postoperative outcomes and characteristic pathologic features in the children who underwent epilepsy surgery. The objective of this study is to summarize experiences of epilepsy surgery in children with intractable partial epilepsies.
METHODS
Forty-seven patients were included in this study. All had medically intractable partial epilepsy and underwent epilepsy surgery after meticulous presurgical evaluation including interictal and ictal EEG, MRI, interictal and ictal SPECT and FDG-PET.
RESULTS
Out of the 47 patients, 28 had temporal lobe epilepsy, 8 frontal lobe epilepsy, 8 occipital lobe epilepsy, and 3 parietal lobe epilepsy. Pathologic findings were as follows: cortical dysplasia in 21, hippocampal sclerosis in 8, cortical dysplasia combined with hippocampal sclerosis in 8, cortical dysplasia with tumor in 4, and cortical dysplasia, hippocampal sclerosis and tumor in 1, tumor in 4, heterotopia in 1. FDG-PET was the most sensitive imaging modality. MRI showed the highest specificity in terms of concordance with ictal EEG finding. Postoperative outcome was as follows: Engel class I in 34, class II in 4, class III in 3, and class IV in 6. No significant difference was found in postoperative outcome between the temporal and the extratemporal resection group. Postoperative seizure outcome was not correlated with MRI or pathologic finding.
CONCLUSION
Epilepsy surgery seems to be an effective and safe therapeutic choice in children with intractable partial epilepsies regardless of the location of epileptogenic zone. Further study is necessary on the efficacy of each imaging modality, postoperative quality of life and the effect on long-term neurocognitive function.