Authors :
Presenting Author: Sanjib Sinha, MD, DM – NIMHANS
Usha Humbi, MD, DM – NIMHANS
Ravindranadh M Chowdary, DM – NIMHANS
Bhargava Gautham, PhD – NIMHANS
Mariyappa Narayanan, PhD – NIMHANS
K Raghavendra, MD, DM – NIMHANS
Ajay Asranna, MD, DM – NIMHANS
L G Vishwanath, DM – NIMHANS
J Saini, MD, DM – NIMHANS
sandhya Mangalore, MD, DM – NIMHANS
R D Bharath, MD, DM – NIMHANS
Nishanth Sadashiva, MS, Mch – NIMHANS
A Arivazhagan, MS, Mch – NIMHANS
Anita Mahadevan, MD – NIMHANS
Jamuna Rajeshwaran, PhD – NIMHANS
M B Rao, MS, DNB – NIMHANS
Rationale:
Pediatric epilepsy surgery is a critical intervention for children with drug-resistant epilepsy (DRE). This study aimed to evaluate seizure outcomes and identify predictors of surgical success in a cohort of pediatric patients undergoing epilepsy surgery.Methods:
We conducted a retrospective analysis of all pediatric patients (< 18 years) who underwent epilepsy surgery at our center and had a minimum postoperative follow-up of six months. Clinical, electrophysiological, neuroimaging, and histopathological data were analyzed. Surgical outcomes were assessed using Engel classification. Logistic regression was used to identify predictors of favorable outcomes.Results:
A total of 184 patients were included (male:female = 117:67), with a mean age of 10.9 years. Of these, 142 underwent resective procedures, 33 underwent disconnectional surgeries, and 18 underwent palliative procedures; 9 patients had combined interventions. Focal cortical dysplasia was the most common histopathological diagnosis (24%) and the temporal lobe was the most frequent site of resection (31%). The Engel 1A outcome was 77% at 6months (n=184), 70% at 1 year (n=158), 66% at 2 years (n=138), 61% at 3 years (n=113) and 62% at 5years (n=69). Patients undergoing resective surgery demonstrated significantly better seizure outcomes (Engel Class I–II) (p=0.003) compared to those receiving palliative interventions (p=0.009). Favorable outcomes were observed in patients with lesional epilepsy, even when the ictal onset zone extended beyond the lesion on video-EEG or when PET hypometabolism was widespread. Longer duration of follow-up was associated with poor outcome and younger are at surgery had good outcome. Resurgery was done in 12 patients (6.5%). Incomplete resection was the most frequent cause of surgical failure, with gliosis being the predominant histopathological finding in such cases. Neuropsychological improvement was observed in the majority of patients (69%), with most resuming school postoperatively.
Conclusions: In pediatric DRE, resective surgery is associated with favorable seizure and functional outcomes. Extensive ictal EEG onset and PET hypometabolism beyond the structural lesion should not be considered deterrents for surgical resection. However, a decline in seizure control over time highlights the importance of long-term follow-up. Incomplete resection remains a key factor in suboptimal outcomes. Early surgical intervention in appropriately selected pediatric patients not only improves seizure control but also enhances cognitive and social reintegration. These findings support the value of individualized pre-surgical planning and long-term outcome monitoring.
Funding: Nil