Abstracts

Rationale: The association of perinatal insults and refractory epilepsy is rarely mentioned in the literature. Perinatal insults including prematurity and associated comorbidities such as hypoxic ischemic encephalopathy often imply multifocal disease leading to less optimal epilepsy surgery outcomes. We studied the prevalence and impact of perinatal injury in children who underwent epilepsy surgery.Methods: A retrospective chart review was performed of all patients who underwent surgical treatment for intractable epilepsy at Children s Hospital of Alabama from 2006-2010. Parameters recorded included perinatal insults such as prematurity (<36weeks gestation), neonatal seizures, stroke, and HIE. Malformations of cortical development (MCD) were only included if found in association with aforementioned types of perinatal injury. Also recorded were types of surgical intervention (resective vs. palliative therapy such as VNS implantation and corpus callosotomy), and seizure outcome at minimum of one year follow-up. Results: One hundred and twenty two children underwent surgical treatment for intractable epilepsy. Perinatal insults occurred in 11 of 122 patients (9%) while 117 had no documented evidence of perinatal injury. Mean age of seizure onset with perinatal insults was 2.3 (0-4 years) vs. 3.9 (0-18 years) in those with no injury (p<0.05). Perinatal insults included prematurity (n=7), neonatal seizures (n=3), stroke (n=7), and MCD (n=3). Prematurity, ranging from 26 to 35 weeks gestation, was seen with infection (n=2), stroke (n=3), MCD (n=2). Neonatal seizures occurred in association with stroke, infection, and MCD. Of the 7 patients with strokes, 3 had hemorrhagic strokes with intraventricular hemorrhage (2) and infection (1), while 3 had arterial strokes. Among the 11 patients with perinatal insults, 10 underwent resective therapy and 1 had palliative therapy. Resective surgeries included functional hemispherectomies in 6 children, and multilobar resection in 4. Palliative therapy included VNS placement and subsequent corpus callosotomy in one patient. Mean age of surgery for the perinatal insult cohort was 6.9 (2.2-12.6 years) vs. 9.6 (0.3-20.6years) in those without perinatal injury. With at least 1 year post surgery follow-up, 9 of 11(80%) had Engel Class I outcome while 1 of 11 was Engel Class II. The patient with VNS and subsequent corpus callosotomy continues to have persistent seizures with mild improvement. Conclusions: Perinatal injury contributed to approximately 10% of refractory epilepsy in our patient cohort who received surgical intervention. Prematurity and stroke were the most prevalent injury, each seen in 7 of 11 patients (68%). Ten of 11 in this cohort had resective surgery including hemispherectomies and multilobar resections, implying widespread areas of cortical irritability and epileptogenicity. Our results show that despite large areas of cortical irritability, optimal surgical outcomes can be achieved in those with early brain injury. Further studies are needed to substantiate our observations and further characterize and optimize surgical outcomes in children with perinatal insults and refractory epilepsy.