Abstracts

Rationale: Patients with intractable epilepsy who have bilateral epileptic foci may not qualify for curative epilepsy surgery; however, palliative resection may be undertaken with a goal to decrease seizure frequency significantly and improve quality of life. Here, we present data on the outcome of palliative epilepsy surgery in children.Methods: We reviewed medical charts of children who had undergone a palliative resection for intractable epilepsy during the years 1999-2013 at Children s Hospital of Michigan in Detroit. Palliative nature of resection was declared preoperatively based on bilateral ictal EEG onsets in these patients. Demographic and clinical data were recorded, and outcome was assessed in terms of seizure reduction and improvement of quality of life (defined by parental perception and clinical evaluation of improvement in one or more of the following domains: self-care, ambulation, language, social skills and cognition).Results: There were 18 patients (11 males, mean age of surgery 5.6 5.1 years). Mean duration of follow up after surgery was 16.6 15.9 years. Multilobar resection was the most commonly performed palliative resection (9 patients), followed by lobectomy (7 patients) and tuberectomy (2 patients). Multiple subpial transections or corpus callosotomy was performed in addition to tissue resection in 4 and 2 patients, respectively. Major surgical complications requiring intervention or recurrent hospitalization were encountered in 2 patients. The mean number of antiepileptic medications used pre-operatively was 4.3 1.6, and declined to 2.7 1.3 post-operatively (p=0.001). Reduction in seizure frequency was seen in 11 patients, with 8 patients achieving seizure freedom, and 3 with more than 50% reduction in seizure frequency. Transient improvement in seizure frequency occurred in 2 patients, whereas there was no benefit observed in 5 patients. Of these 5 patients, one was subsequently diagnosed with Dravet syndrome, and another one was suspected of having Dravet syndrome. Improvement in quality of life was seen in 11 patients. All these patients also had a significant reduction in seizure frequency.Conclusions: Palliative surgical resection is a viable option for some patients with intractable epilepsy and multifocal bilateral epileptic foci. If carefully selected, the majority of these patients experience a significant reduction in seizure frequency and improved quality of life. In our series, 8 of 18 patients actually achieved seizure freedom. The intent of performing palliative surgery must be declared preoperatively so that parents can be counselled as to expectations from surgery. Prospective studies analyzing its efficacy and outcome may help better define the role of palliative resection in this group of patients.