Abstracts

Rationale: RATIONALE: We recently opened a level 4 Comprehensive Epilepsy Center at Children's Hospital Los Angeles, a hospital that had previously been without a surgical Epilepsy program for many years. Our team initially consisted of one epileptologist, two pediatric Neurosurgeons, one pediatric Neuropsychologist, two pediatric neuroradiologists, a nuclear medicine specialist, hospital medicine staff, physical medicine and rehab, OT/PT specialists, nurse care manager, and EEG technologists. Since opening, we have added additional staff including epileptologists, neurosurgeon, physician assistant, nurse care manager, and EEG technologists. Our 4 bed Epilepsy Monitoring Unit (EMU) opened in September 2014 and is staffed 24/7 with nurses and EEG technologists. We have thus far operated on a total of 39 patients and report here our results. Methods: METHODS: Most patients underwent a Phase I pre-surgical evaluation including video/EEG monitoring, 3T MRI, neuropsychological evaluation; some patients also had a functional MRI, PET scan, an interictal/ictal SPECT scan, and/or Wada study. Patients were then presented at epilepsy surgery conference to determine the surgical plan. A database is maintained to track patient's surgical evaluation progress, results, and follow-up. All patients followed standard follow-up protocols for clinic visits and MRI's (6 months post-operative), EEG's (6 months post-operative), and Neuropsychological testing (one year post-operative). Results: RESULTS: Background information and etiologies are listed in Tables 1 and 2. Surgical follow-up ranges from two to nineteen months. Of our 39 patients, eighteen had resection with electrocorticography, fifteen had Phase II surgery, including implantation of grid, strip, and depth electrodes, and five had functional hemispherotomies. All fifteen Phase II patients spent one night in the pediatric intensive care unit (PICU) before transferring to the EMU. Seven of the Phase II patients required cortical stimulation to map areas of eloquent cortex. All of the patients who were mapped underwent functional MRI prior to surgery to guide placement of electrodes. No unanticipated complications occurred with any surgeries. One patient with cortical dysplasia in the motor area experienced post-operative weakness that was explained and agreed upon prior to surgery. One patient underwent Phase II implantation of bi-frontal grids without clear seizure localization and did not undergo resective surgery. Overall, 89% of patients who received surgery are designated as Engel class I. An additional 7% are Engel class II and the remaining patients are Engel class III. All five hemispherotomy patients are seizure free. Table 1 ETIOLOGY RESECTION HEMISPHEROTOMY Tumor 17 Cortical Dysplasia 7 1 Gliosis 3 Tuberous Sclerosis 1 Stroke 1 1 Cavernous Malformation 2 Traumatic Brain Injury 1 Sturge-Weber Syndrome 1 Hemimegalencephaly 1 Mesial Temporal Sclerosis 2 Table 2 REGION LEFT RIGHT Temporal 10 8 Frontal 8 5 Parietal 1 Occipital 1 Hemispherotomy 4 1 Conclusions: CONCLUSION: Epilepsy surgery offers some children with drug resistant epilepsy a chance to significantly treat an otherwise incurable neurological disorder. Since epilepsy surgery has been shown to be safe and effective, it should be considered promptly once drug resistance is determined, not as a last resort. Our post-surgical outcome of 89% of patients earning designation of Engel class I exceeds national standards; confirming our ability to build a successful program in a relatively short period of time. Funding: None