J Korean Child Neurol Soc.  2005 Nov;13(2):165-171.

Results of Surgical Treatments on Intractable Epilepsy with Infantile Spasm

• Lee YM
• Noh BH
• Hur YJ
• Eun SH
• Kang HC
• Lee JS
• Kim HD

Abstract

PURPOSE
Infantile spam is a kind of epileptic syndrome causing delayed psychomotor development in children and one of the most common type of epileptic encephalopathy. Some cases of infantile spasm are known to be caused by focal abnormalities of cerebral cortex thus curable by operating them. Here we analyzed the results of surgical treatments on intractable epilepsy with infantile spasm.
METHODS
We performed retrospective study on 22 patients with infantile spasm who received epileptic surgery since 1999. Surgical outcome, pathologic findings, localization of lesions, and types of surgery were reviewed.
RESULTS
Sex ratio of our 22 cases was 1:1.4(M:F) and the age at surgery was quite variable. The mean duration from diagnosing epilepsy till operation was 6-10 years in 8(36%) cases, 1-2 years in 7(32%). In preoperative EEG, abnormalities implying possible focal lesion were seen in all 22 patients. 7(32%) out of 22 cases showed focal lesions in MRI while 12(92%) out of 13 cases in ictal SPECT, 8(62%) out of 13 cases in interictal SPECT, and 11(61%) out of 18 cases of PET examination showed abnormal findings. Concerning the types of surgery, single lobectomy was most commonly performed, in 13 (59%) cases in which 11 among them received frontal lobectomy. Also, multilobar resection was performed in 6(27%) cases and hemispherotomy in 2(9%) as well. 19(86%) patients were classified as Engel class I after operations. In pathological examination, cortical dysplasia was most commonly observed, in 11(50%) cases, microdysgenesis in 3(14%), gliosis in 2(9%), and tuberous sclerosis in 2(9%).
CONCLUSION
In cases of children with infantile spam not controlled by medical treatment, epileptic surgery should be strongly considered when cortical pathology can be identified from various studies.

Keyword

Infantile spasm; Epilepsy; Surgery; Cortical dysplasia

MeSH Terms

Cerebral Cortex
Child
Electroencephalography
Epilepsy*
Gliosis
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging
Malformations of Cortical Development
Pathology
Retrospective Studies
Sex Ratio
Spasms, Infantile*
Tomography, Emission-Computed, Single-Photon
Tuberous Sclerosis