Abstracts

RATIONALE: Resective surgery is successful in 50 to 90% of children with intractable lesional epilepsy but the outcome in children without a lesion is still unclear. METHODS: 143/354 children undergoing resective surgery at Miami Children s Hospital had normal or non-specific CT/MRI scans (non-lesional). Of the 143, we analyzed 84 children had sufficient data for analysis.There were 46 M, 38F) aged 7 months to 18 yrs (mean= 10.3 yrs) and a follow up of 2-15 years (mean=10.1 yrs) The epileptogenic region was identified on the basis of scalp video-EEG (n=84), Ictal SPECT (n=26), subdural monitoring (n=45 ) and electrocorticography (n=80). Seizure outcome was classified as seizure-free, > 90% reduction, > 50% reduction and < 50% reduction. RESULTS: Resections were: temporal lobe (n=24), extratemporal (n= 40), multilobar (n=15) and hemispherectomy (n=5). Two patients also had multiple subpial transection. 43/84 (51.5 %) are seizure free, 15 (18%) experienced >90% reduction, 10 (12%) had > 50% reduction, and 16 (19 %) were unchanged. There were no significant differences in the outcome based upon location or extent of resection. CONCLUSIONS: Even in the absence of a lesion on CT/MR imaging, resective surgery is benefitial for the majority of children with intractable epilepsy with over half being rendered seizure free. Localization of the epileptogenic focus or extent of resection did not make a difference in the outcome. While ictal SPECT studies have reduced the need for invasive EEG monitoring, the two modalities together achieve gratifying results even with limited resections averting the deficits associated with multilobar/ hemispheric surgeries.