Abstracts

Rationale: Epileptic spasms are refractory to medical management and a surgical option is recommended in selected patients. Although many centers have gained experience in surgery for intractable ES when there is an MRI visible lesion. The concordance between interictal EEG and MRI visible lesion may resulted in excellent outcomes. The stury  evaluated the electroclinical features, etiology, treatment, and postsurgical seizure outcomes of 26 patients with intractable epileptic spasms (ES). Methods: We retrospectively studied 26 (12 boys and 14 girls; 3-22 years) patients who presented with ES and underwent surgery. We compared the interictal electroencephalographic (EEG) pattern, magnetic resonance imaging (MRI), magnetoencephalography (MEG), and postsurgical seizure outcomes.  Results: Of the 26 patients, 84.6% (n = 22) presented with multiple seizure types, including partial seizures (PS) (30.8%), ES followed by tonic (30.8%), myoclonic (19.2%), and tonic (19.2%) seizures, ES followed by partial seizures (PS) (ES-PS) (19.2%), focal seizures with secondary generalization (15.4%), atypical absence (11.5%), PS followed by ES (PS-ES) (7.7%), and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and nine patients underwent unilobar resection. At last follow up (mean 36.6 months), 42.3% of patients were seizure free, 23.1% had 50%-90% reduction in seizure frequency, and 34.6% remained refractory. Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI lesions (p = 0.001and, 0.004, respectively).  Conclusions: ES are secondary to structural lesions and a very favorable surgical outcome can be achieved in a highly selected group of patients.   Funding: National Natural Science  Foundation of ChinaNo: 81471328