Surgical Treatment of Medically Refractory Epilepsy in Childhood

Kang, Hoon Chul; Kim, Heung Dong; Hwang, Yong Soon; Park, Sang Geun

Abstract

PURPOSE: Recent advances in neurophysiology and neuroimaging provided surgical application in intractable childhood epilepsy with improved outcome. The aim of this study is to reveal benefit and safety of epileptic surgery in childhood by reviewing our experiences. METHOD: Thirty patients who underwent epilepsy surgery from February, 1997 to June, 2002 at epilepsy center, Inje University Sang-gye Paik Hospital, were included. We reviewed clinical features and outcomes according to temporal/extratemporal epilepsies including generalized or undertermined epileptic syndromes.
RESULTS
In 8 patients of temporal lobe epilepsy, surgical procedures were as follows, anterior temporal lobectomy (ATL) was in 6 patients, ATL and extended temporal resection in 1, ATL and multiple subpial transection (MST) in 1. Pathologic findings showed cortical dysplasia, hippocampal sclerosis, tumor and old infarction. Engel class I was in 6 (75%) patients and class II was in 2 (25%) patients. Six patients (75%) showed developmental progress. In 22 patients of extratemporal lobe epilepsy, various surgical methods such as partial or total lobectomy, functional lobectomy, corticectomy, functional hemispherectomy, peri-insular hemispherotomy, multiple subpial transection, lesionectomy and palliative corpus callosotomy were done according to the location of epileptic focus and epileptic syndromes. Engel class I was in 16 (72.7%) patients, class II in 4 (18.2%) and class III in 2 (9.1%) patients. Eight patients (66.6%) among 12 patients could have been followed for more than 12 months showed developmental progress. Most of neuroimaging studies were highly concordant to ictal EEG's.
CONCLUSIONS
Epilepsy surgery is effective in most of localization related intractable childhood epilepsy and developmental acceleration can be expected in successfully treated patients.