Abstracts

Rationale: The purpose of this study is to evaluate the results from epilepsy surgeries in drug resistant epilepsy patients, especially in those with catastrophic epilepsy. A large sample size of 440 operations, referred from the Pediatric Epilepsy Clinic at the Severance children s hospital from February 2003 to March 2011, was used in this study.Methods: A retrospective analysis of a grand total of 440 procedures in 364 patients from February 2003 to March 2011 was performed. Results: The age of the patients at surgery ranged from 3 months to 28 years old (median = 9.5 years). Most frequent etiologies were malformation of cortex, destructive encephalopathy, hippocampal sclerosis, tumor, hypothalamic harmatoma, tuberous sclerosis complex, and others. Seizure outcomes were classified as Engel class I in 200 patients (45%), Engel class II in 19 (4%), Engel class III in 69 (16%), and Engel class IV in 142 (32%). The overall surgical outcomes, including reoperations, had 193 (53%) patients in class I, 14 (4%) in class II, 59 (16%) in class III, and 88 (24%) in class IV. There was a significant difference between the seizure outcomes of resective surgery and non-resective surgery. Resective surgeries had 166 (62%) outcomes in class I, 14 (5%) in class II, 31 (12%) in class III, and 57 (21%) in class IV. Non-resective surgeries that included VNS, corpus callostomy and MST had relatively less favorable outcomes with 27 (19%) in class I, 5 (4%) in class II, 33 (23%) in class III, and 76 (53%) in class IV. Another point to note is that 53% of the patients (293 patients) were diagnosed with catastrophic epilepsy such as early infantile epileptic encephalopathy with suppression bursts, West syndromes, Lennox-Gastaut syndrome, and Dravet syndrome. Resective surgeries performed on 118 of these patients had positive outcomes with 64 (54%) in class I, 6 (5%) in class II, 17 (14%) in class III, and 28 (24%) in class IV. Conclusions: Out results support previous reports that surgeries for intractable epilepsy in pediatric patients can be safely performed with satisfactory long-term results.