Surgical Experiences on a Case by Case Basis for Intractable Childhood Epilepsy

Kim, Yong Joo; Hwang, Yong Soon; You, Su Jeong; Kang, Hoon Chul; Park, Sang Keun; Ko, Tae Sung

Abstract

PURPOSE: This study aimed to reveal the benefits and the safety of surgical treatment in children with refractory epilepsy by reviewing our experiences on a case-by-case basis.
METHODS
Twenty one patients who underwent epilepsy surgeries from September, 2003 to March, 2005 at Sanggye Paik Hospital were included. Data including clinical features and surgical outcomes were filed up through 2 years.
RESULTS
The profiles of the 15 patients who underwent curative epilepsy surgeries were as follows. Characteristically, one patient had dual epilepsy including mesial temporal lobe epilepsy. Two patients had infantile spasms with cortical dysplasia, both of whom underwent epilepsy surgeries in early infancy. Also, there is a patient who underwent a re-operation, while another one patient had an epileptic focus in the insular lobe. Two patients were diagnosed Sturge-Weber syndrome, and three patients had nonlesional or lesional multilobar epilepsies. Furthermore, the surgical outcomes can be classified such as Engel class I in 10(66.7%) patients, class II in 3(20.0%) patients while one patient failed to obtain any seizure reduction after surgical treatment. In addition, palliative total corpus callosotomies were tried in 6 patients. But only one patient showed seizure reduction of more than 90%, while 4 patients exhibited 50-75% seizure reduction and the other one did not have any changes in seizure frequency. We also experienced various kinds of unwanted events such as memory deterioration (1), vascular infarction (1), hypoxic insult (1), transient hemiparesis (2), dysinhibition (1) and visual field defects (3). Most of neuroimaging studies were highly concordant to the ictal scalp and intracranial EEGs.
CONCLUSION
Epilepsy surgery can be an effective therapeutic modality in localization related intractable childhood epilepsies. However, we should consider various surgical complications and carefully evaluate the epileptogenic and functionally eloquent areas.