Abstracts

Rationale: The traditional goal of focal resective epilepsy surgery is seizure freedom. However, procedures not expected to result in seizure freedom may still benefit patients with bilateral independent ictal onset or those for which complete resection of the epileptogenic zone is not possible. We describe our experience using epilepsy surgery as a palliative treatment for intractable pediatric epilepsy. Methods: We identified and retrospectively reviewed charts of patients who underwent palliative cortical resections for treatment of intractable epilepsy between 1/2010-6/2013 using the Cook Children s Comprehensive Epilepsy Surgery Database. Patients that did not provide consent to the database or those that underwent VNS implantation or corpus callosotomy alone were excluded. Data including baseline demographics, seizure type, etiology, reason procedure was classified palliative, surgical details and outcome by Engel s classification were abstracted. Descriptive data is presented. Results: Thirteen patients were included, 8 were male. The mean age at surgery was 12.82 years and patients had been exposed to a mean of 6.3 AED trials prior to surgery. All patients had localization-related epilepsy. Two procedures were palliative secondary to proximity of eloquent cortex to the epileptogenic zone and 10 due to bihemispheric independent ictal onset zones in which one side was disproportionally responsible for the patients seizures. At 6 months post-op6 (46%) patients reported >50% reduction in seizure frequency, 2 (15%) were Engels 1 or 2. At 1 year post-op, 7 (54%) patients reported >50% reduction in seizures, 2 (15%) were Engels 1 or 2, and one patient (8%) was lost to follow-up. Four patients are 2 years post-op with one demonstrating >50% reduction in seizures, whereas the other 3 had never experienced seizure reduction post-op. There was no difference in the number of AEDs patients were taking comparing pre-operative to post-operative status.Conclusions: Nearly half of our patients undergoing palliative focal resections for intractable epilepsy achieved at least 50% seizure reduction. One patient with independent temporal lobe onset became seizure free. These favorable outcomes were sustained at 1 year post-op and suggest palliative epilepsy surgery may be as effective as additional medication trials in appropriately chosen candidates. However, palliative epilepsy surgery did not afford a reduction in AED burden for the patients included in our cohort. This study is limited by small sample size and retrospective design. Prospective studies examining other measures of outcome in addition to seizure freedom (i.e. quality of life, costs, cognition) will better characterize the value of palliative resective surgery as a treatment option.