Abstracts

Seizures in the first week following surgery for epilepsy can be alarming and raise concerns about long term seizure outcome. Data on predictive value of acute post operative seizures (APOS) is limited in children. We assessed the incidence and predictive value of APOS (within a week after surgery) on one year seizure outcome following extratemporal epilepsy surgery in children and adolescents. 132 consecutive children (age at surgery 6 months to 18 years, mean 7.8) who underwent extratemporal surgery for epilepsy (61 hemispherectomies (HS), 71 extratemporal resections (ETR)) between 1995-2002 were studied. Odds for [italic]good seizure outcome[/italic] (seizure free, only auras) at one year were compared in children with and without APOS (nAPOS). Of 132 patients, 107 (81%) had daily preoperative seizures and 16 were less than one year-old at surgery. 34 of 132 (25%) had APOS. Of 34 patients with APOS, 28 (82.4%) had more than one APOS, and 16 (49%) had no change in semiology from preoperative seizures. 8 of 34 (23.5%) had postoperative medical or surgical complications (complicated APOS). APOS were more frequent after ETR (26/71) than after HS (8/61) (p[lt]0.01, chi² test). There was no significant difference in the seizure onset age, preoperative seizure frequency, age at surgery and the incidence of medical (fever, aseptic meningitis) or surgical complications in APOS and nAPOS groups.
23 patients were excluded for the one year seizure outcome analysis due to a second surgery within a year (14, 7 each after HS and ETR) or loss of follow up (9). Of 109 patients with one year of follow up, 24 had APOS. 10 of 24 with APOS (41.6%) and 72 of 85 without APOS (84.7%) had [italic]good outcome[/italic] at one year (, 95% CI 2.86-20.98). There was no significant difference in the incidence of [italic]good outcome [/italic]at one year in patients whose APOS semiology was similar to their preoperative seizures (6/14) compared to those with new APOS semiology (5/10) (p[gt]0.05 Fisher[apos]s exact test ). 3 of 8 children with complicated APOS had a good one year outcome compared to 6 of 16 with uncomplicated APOS (APOS without medical/surgical complications) (p[gt]0.05, Fisher[apos]s exact test). Acute post-operative seizures occurred in 25% children after extratemporal epilepsy surgery. They were significantly more frequent after extratemporal resection than after hemispherectomy. Children with APOS had a significantly lower likelihood of good seizure outcome at one year compared to those without APOS. The similarity of APOS semiology to preoperative seizures, and presence of medical/surgical complications during APOS did not influence the one year outcome.