Abstracts

RATIONALE: Outcome with regard to seizure control after frontal lobe surgery is generally poorer than after surgery for temporal lobe epilepsy. Therefore etiologic, pathologic and clinical features of possible prognostic significance were studied in children and juveniles who underwent frontal lobe epilepsy surgery. METHODS: 32 children and juveniles were operated on for frontal lobe epilepsy. Their medical records were reviewed for ictal semiology, age at seizure onset, duration of the epilepsy, age at operation, electroencephalographic findings, abnormalities on neuroimaging, surgical procedures, pathological findings and follow up. RESULTS: Mean age at operation was 10.8 years (range 1-17 years) and mean age at seizure onset 4.6 years (range 0.3-12 years). After a mean follow up of 21.1 months 63% (N=20) had an excellent outcome, i.e. seizure free, auras only, or recurrence of seizures only on withdrawal of medication. In addition to a tailored resection (N=22) multiple subpial transsections were used in eloquent epileptogenic area (N=9). 10 patients without a focal ictal onset had a lobectomy. Transient neurological complications occurred in 6 and surgical complications in 3 patients. There was no mortality. In most cases (N=25) the pathologic substrate was a non-tumoral lesion with gliosis as the most common diagnosis (N=9). Demographic data were not accociated with the postoperative seizure activity. A focal ictal onset, an invasive preoperative electroencephalographic evaluation, a focal abnormality on neuroimaging and tailored resection were associated with good outcome. The incidence of a preoperative history complicated by developmental brain disorders and brain tumors resected without preoperative evaluation in an Epilepsy programm, was higher in the group with poor outcome. CONCLUSIONS: A careful driven invasive EEG evaluation and and a tailored resection of a focal ictal abnormality can result in good surgical outcome in children and juvenile with frontal lobe epilepsy and non-tumoral lesions.