Abstracts

Rationale: An ILAE Pediatric Epilepsy Surgery Taskforce recently defined the spectrum of the international practice of pediatric epilepsy surgery from data compiled from 20 select programs worldwide. In order to determine the general applicability of the ILAE data, we analyzed the surgical data from our pediatric epilepsy surgery practice in a non-participating tertiary care children’s hospital. Methods: Retrospective chart review identified 141 patients who underwent epilepsy surgery at Texas Children’s Hospital between years 2002. and 2008. Demographic features and seizure variables were recorded. Patient data were converted into a spreadsheet for statistical testing (SPSS v 14.0). Statistical tests included t-test, ANOVA, and chi-square test, each done when appropriate. We compared our data with the published data from the ILEA 2004 survey Results: Mean age at the time of surgery and seizure onset was 8.78+/- 5.1.4 years (range 1 to 18 years, median 8 years) and 3.7+/-3.4 years (range 0 to 17 years, median 2 years), respectively. Age of onset was 1 year or less in 37.4% of patients. The time from seizure onset to epilepsy surgery was 5.1+/-4.5 years. Older patients had longer seizure duration than younger patients (ANOVA p<0.0001). Out of 72 patients with seizure onset before 2 years of age, 25 patients (34.7%) had seizure duration of 2 years of less at the time of surgery. Thus, only one third of younger children with seizures who were at greatest risk of epileptic encephalopathy had surgery within 2 years of seizure onset. The most common surgery performed was temporal and frontal lobe resection (67%), and hemispherectomy (19.9%) Resective procedures were performed equally on the left (n=63) and right (n=54). The most frequent etiologies were cortical dysplasia (40.4%), brain tumor (18.4%) and mesial temporal sclerosis (14.9%). Less common were Rasmussen syndrome (9.9%) and strokes (6.4%). Children 4 years or less were more likely to undergo hemispherectomy and have cortical dysplasia, hemimegalencephaly and tuberous sclerosis. By comparison, children 8 to 18 years were more likely to undergo lobar and focal resections for cortical dysplasia, tumor and hippocampal sclerosis. MRI finding was definitive in 95.7% and normal/subtle in 4.3%. No major complications were reported immediately after surgery