Abstracts

Pediatric epilepsy surgery is being increasingly utilized in the treatment of intractable epilepsy in the pediatric population, but is often delayed or considered a treatment of last resort. Adult patients with epilepsy usually have a 15+ year history of uncontrolled seizures before being referred to a tertiary epilepsy center. We have aggressively pursued epilepsy surgery in our pediatric population, with the rationale that early treatment results in improved seizure control, enhancement of development, and improved quality of life. This was a retrospective chart review of 56 patients who underwent epilepsy surgery at Children[apos]s Hospital of Wisconsin between 2001-2003. Age range for our pediatric surgical patients was 6 months to 18 years of age, with a mean age of 9 years. Of the 56 surgeries, 28.5% were hemispherectomies; 27% frontal resections; 12.5% temporal-parietal-occipital resections; 10.5% parietal resections; 21.5% temporal lobectomies. Pathology revealed 57% cortical dysplasia; 11% encephalomalacia; 9% tuber; 9% mesial temporal sclerosis; 7% Rasmussen[apos]s encephalitis. Seizure outcomes have been Class I--68.8%; Class II--12%; Class III--9.2%.
Presurgical evaluation included CCTV EEG monitoring, MRI scan of the brain, PET and SPECT imaging. The EEG was nonlocalizing in 50% of the cases, suggestive of a generalized or multifocal epilepsy. The critical determinant for location of the epileptogenic zone was neuroimaging--primarily the MRI scan (75%) in combination with either PET or SPECT. PET scan was approximately 50% sensitive. SPECT scans were not performed on all patients, but provided congruent information in 60%.
The follow-up has ranged from one month to two and one half years. The patients in the Class III outcome were predicted to have a reduction in seizure burden, but not complete elimination of seizures. Despite this, 95% of families have reported improved development and enhancement of quality of life.
Further information about presurgical evaluation, surgical techniques, and quality of life assessment will be provided in greater detail at our presentation. Early surgical intervention in appropriate pediatric candidates provides a reduction in seizure burden, improved quality of life and enhanced development.