Abstracts

A significant percentage of medically refractory pediatric epilepsy patients may be cured by epilepsy surgery. However, epilepsy surgery continues to be underutilized, and even the [lsquo]good surgical candidates[rsquo] i.e. those patients who become seizure free after surgery, typically reach their cure after incurring significant years of morbidity due to ongoing epilepsy and failed medicine trials.
[underline]Objectives:[/underline] 1) To assess pre operative burden of epilepsy in pediatric epilepsy patients who underwent epilepsy surgery and who were seizure free for at least 6 months after surgery 2) To assess the long term follow up in this population
From a database, 97 patients were identified who 1) had surgery before their 19^th birthday for medically refractory epilepsy at our institution between 1978-2001 2) were free of seizures or had rare nondisabling auras only during the first 6 postoperative months; 3) had a follow up of at least 12 months. Pre operative epilepsy characteristics including age of seizure onset, frequency of seizures, number of AEDs tried, time lapsed between onset of seizures to surgery and their post operative course was studied.
Onset of seizures was from birth to 13 years (median 3 years). Both sexes were equally represented (47 males, 50 females). Seizure burden until the time of surgery in these patients was 35 seizures (median) per month. Age at surgery varied from 3 months to 18.75 years (median 11 years). Time lapsed between onset of refractory seizures to epilepsy surgery was up to 18 years (median 5.5 years). 50% of the patients had been tried on 5 to 10 AEDs before surgery. A median of 4 AEDs were tried in the whole group.
AEDs were discontinued 2-126 (median 13) months after surgery in 68 patients. At 6 year median follow up, overall 64 (94%) were seizure free with or without medications. 57 (84%) never had seizure recurrence after AED taper, 7 (10%) had breakthrough seizures which were subsequently controlled by AED monotherapy and 4 had rare breakthrough seizures despite restarting AEDs.
AEDs were continued postoperatively in 29 patients, due to seizure recurrence later than 6 months after surgery (in 4 patients) or patient, family, or physician preference (in 25 patients). At follow up, 7 to 134 months (median 3 years) after surgery, 28 patients (96.5%) on continued AED monotherapy had no further seizures and 1(3.4%) had rare seizures.
Our data reiterates the significant role of epilepsy surgery in curing carefully selected, medically refractory pediatric epilepsy patients. It also highlights the substantial delay that frequently occurs before these patients are referred for epilepsy surgery. During this delay the patients are subject to multiple AED trials and a significant seizure burden. With studies that have helped us in early prediction of medical refractoriness (adequate trial and failure of 2 AEDs), it is important that we identify appropriate surgical candidates for prompt intervention.