Abstracts

The literature suggests that candidates for pediatric epilepsy surgery who present in status epilepticus (SE) or with very frequent seizures are an unusual occurrence. However, this concept is based on case reports, and the incidence and clinical characteristics of these patients has not been systematically assessed. The cohort consisted of all resective pediatric epilepsy surgery cases from 2000 to 2005 (n=115). Patients were classified as presenting with continuous SE requiring medical suppression therapy (seizure [gt]20 min, n=6) or intermittent SE ([gt]3/hr; n=17). The SE categories were compared with extratemporal surgery patients without SE (n=64) for differences in clinical variables abstracted from the medical record. This included pre-surgical information (age at seizure onset, age at surgery, estimated seizure frequency/hr, days from onset of increased seizure activity to surgery, gender), peri-operative variables (type of surgery, side-resected, imaging/pathology), and postoperative variables (number of anticonvulsants and seizure frequency, complication). Statistical analysis on these variables using ANOVA, Games-Howell post hoc test and Chi-square tests were performed. Continuous SE was noted in 5% and intermittent SE in 15% of resective surgery cases, and all had extratemporal cortical involvement. Compared with continuous SE and non-SE cases, intermittent SE patients were younger at surgery and with a shorter duration of seizures, and increased incidence of active infantile spasms during video scalp EEG monitoring. Compared with non SE cases, the continuous SE and intermittent SE groups required a larger number of anti-epileptic medications pre- and 6-months post-surgery, underwent hemispherectomy more frequently, and had an increased incidence of hemimegalencephaly and Rasmussen encephalitis and a lower occurrence of infarct/ischemia and infectious etiologies. Seizure control was over 71% up to two years post-surgery, and there were no differences between patient groups. Finally, seizure frequency per hour was greater in continuous SE cases compared with the intermittent SE group. Children presenting with SE or frequent seizures are not rare in pediatric epilepsy surgery centers, and such cases are more commonly associated with infantile spasms, Rasmussen syndrome, and hemimegalencephaly pathologies. Seizure outcome after surgery was not altered in pediatric patients because they had presented with continuous or intermittent SE.