Abstracts

Many clinical variables are considered when selecting pediatric epilepsy surgery candidates with the objective of predicting beneficial outcome., We analyzed all pediatric patients who underwent initial resective surgery at Minnesota Epilepsy Group from Jan 2000-Dec 2002. Beneficial outcome was defined as Engel class I or II. Beneficial outcomes were compared to many diagnostic variables: attainment of early childhood milestones, presence of nocturnal seizures, history of febrile seizures, history of status epilepticus, symptomatic versus cryptogenic etiology, temporal vs. extra-temporal lobe seizures, complete vs. partial resection, and presence of multiple conflicting diagnostic variables. Outcome measurements were done at 24-months. Statistical method utilized was Fisher[apos]s Exact Test., 46 consecutive subjects were identified and reviewed; 23 (50%) underwent temporal lobe only resection; extra-temporal resections included 10 (22%) frontal, 1 (2%) parietal, and 12 (26%) multi-lobe. In subjects with available follow-up data, 19/33 (58%) were seizure free at 24-months. Achievement of early childhood milestones was not associated with beneficial seizure outcome. The clinical history of nocturnal seizures, febrile seizures, or status epilepticus did not statistically separate beneficial outcomes groups. Etiology was not a statistically significant influence on beneficial outcome at 24-months (symptomatic 23/30: 77%; cryptogenic 1/3: 33%; p[lt]0.174); however, this is may be influenced by low numbers within the cryptogenic group. Temporal lobe surgery was statistically more successful in achieving a beneficial outcome of Engel I-II in 15/17 (88%) subjects compared to 9/16 (56%) of the extra-temporal group (p[lt]0.046). Complete resection of the epileptogenic zone was associated with beneficial outcome in 20/24 (83%) subjects compared to partial resections 4/9 subjects (44%)(p[lt]0.039). The presence of multiple conflicting diagnostic variables was the strongest predictor of beneficial outcome as 24/27 (89%) subjects achieved Engel I-II compared to none of the 6 subjects with [gt]1 contralateral diagnostic variable (Fisher[apos]s Exact test p[lt]0.001)., Favorable diagnostic variables associated with an Engel class I-II outcome following epilepsy surgery include temporal lobe resections, complete resections, and absence of multiple contralateral diagnostic variables. In this retrospective review, the absence of multiple contralateral variables was the strongest predictor.,