Surgery for Refractory Childhood Parietal and Occipital Epilepsy.
Abstract number :
2.319
Submission category :
Year :
2001
Submission ID :
119
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
I. Valencia, M.D., Neurology/Div. of Epilepsy & Clin. Neurophysiology, Children[ssquote]s Hospital/Harvard Medical School, Boston, MA; M. Connolly, M.D., Neurology/Div. of Epilepsy & Clin. Neurophysiology, Children[ssquote]s Hospital/Harvard Medical Schoo
RATIONALE: To evaluate the surgical outcome for refractory parietal and occipital epilepsy in children.
METHODS: The records of children who had cortical resections of the parietal or occipital lobes for refractory epilepsy at Children[ssquote]s Hospital, Boston, between 1975 and 2000 were evaluated. Charts were assessed in regard to demographics, past medical history, seizure characteristics, neuropathological findings, surgical outcome and complications. Neurophysiological, functional and imaging studies were reviewed. Surgical outcome was scored with Engel[ssquote]s classification of post operative outcome.
RESULTS: Twenty-three patients had cortical resection of the occipital or parietal lobe due to refractory epilepsy during the time of the study. Thirteen patients had parietal resection and 10 patients occipital resection. At the time of resection 20 patients were children and 3 were adults with a mean [plusminus] SD age of 9.5 [plusminus] 6.8 years.
The most common neuropathology findings were a tumor in 6 patients (26%), cortical dysplasia in five patients (22%), gliosis/encephalomalacia in 3 (13%), cortical calcification in 2 (8.7%), and a tuber in 2 (8,7%).
Thirteen patients (56%) had a marked reduction in seizures (Engel[ssquote]s post operative surgical outcome classification class I or II). Five patients had post operative surgical outcome class IV (22%). Patients with a parietal focus showed a better surgical outcome than patients with an occipital focus.
Three patients had residual spikes on electrocorticography after resection and this correlated with a worse outcome.
CONCLUSIONS: We have performed surgery for childhood intractable parietal and occipital seizures in 23 patients. Post resection spikes during electrocorticography correlated with a worse outcome. This study demonstrates that parietal and occipital lobe epilepsy surgery is beneficial in children.