Abstracts

Rationale: Intractable epilepsy in infants is often characterized by its catastrophic nature and significant consequences on development. Although early surgical intervention may be necessary for these children, surgical indication and prognosis is not fully investigated. Methods: Seventy-three consecutive intractable epilepsy children treated by resective surgery between 1993 to April 2006 were divided into four groups according to the age at surgery; i.e., A (<12mo: n=15), B (1-5y.o.: n=16), C (6-10y.o.: n=17), D (11-15y.o.: n=25), and etiology, surgical procedures, and prognosis were compared. Follow-up period was 2 to 15 years (mean 6.3y). Preoperative evaluation included video-EEG monitoring, PET, MEG and ictal SPECT. Intracranial EEG monitoring was performed in 19 patients (3y-15y, mean:10.2y). Results: Etiology included hemimegalencephaly (A: 8 cases), cortical dysplasia (A:11, B:11, C:9, D:8), tumors and vascular lesions (A:4, B:3, C:4, D:8), ulegyria (B:1, C:4, D:3), hippocampal sclerosis (D:3), and gliosis (B:1, D:3). Surgical procedures were hemispherotomy (A:8, B:1), multilobar resection/disconnection (A:2, B:1, C:2, D:3), and focal cortical resection/lesionectomy (A:5, B: 14, C: 15, D: 22). Engel’s class I outcome was obtained in 80% in A, 75% in B, 65% in C, and 80% in D, which corresponded to 63% of hemimegalencephaly, 74% of cortical dysplasia, 95% of dysplastic tumor/angioma, 63% of ulegyria, 100% of hippocampal sclerosis and 25% of gliosis. Conclusions: In infants, extensive developmental pathology is often demonstrated, but favorable surgical prognosis can be obtained as in elder age group of children by choosing appropriate resective procedures based on careful imaging studies.