Abstracts

Rationale: The cause of epileptic spasm (ES) has been considered to be related with widespread epileptic networks including cerebral hemisphere and thalamus. In the case with medically intractable epilepsy, surgery could  be a therapeutic option, however even with the surgical treatment, there are some cases without achieving seizure relief. This study aimed to examine the seizure outcomes of surgery for ES in our institutions.  Methods: 151 patients (209 surgeries) with medically intractable epilepsy underwent epileptic surgery between May 2015 to April 2019 in our institutions. Among them, we excluded cases with epileptic syndrome presenting various seizure type including ES, and cases with ES only in the past. Thirty-seven patients (48 surgeries) were presented with ES as the most disabling seizure type and were retrospectively reviewed. Among them, patients were followed up over one year after the last surgery and were evaluated their seizure outcomes. Patients underwent only CC and were evaluated with Oguni’s classification (Group 1). Patients underwent some kind of focus resection or disconnection and were evaluated with ILAE classification (Group 2).  Results: Thirty-seven patients with ES as the most disabling seizure type were composed of 20 males and 17 females and their age was 5.7 years old in average, ranging from 4 months to 16 years. Initial surgeries were corpus callosotomy (CC) in 31 cases, hemispherotomy in 2 cases, frontal lobectomy or disconnection in 3 cases, subtotal hemispherotomy in one case. Eight cases underwent additional resection or disconnection of the epileptic focus to cure after CC. Three cases underwent vagus nerve stimulation therapy (VNS) after intracranial surgeries. The outcomes in Group 1 showed that 4 patients were Class A, 1 patient was Class B, 6 patients were Class C, and 8 patients were Class D and none of the patients were Class E. Over 50 % improvement (A,B and C in Oguni’s classification) was defined as favorable prognosis in the present study. Fifty eight percent of patients in Group 1 demonstrated favorable prognosis. The outcomes in Group 2 showed 7 patients were Class 1 and 3 patients were Class 5. Seventy percent of patients in Group 2 achieved complete seizure free after surgery. Three patients underwent VNS were Class 5. Conclusions: Even when the medical treatment is insufficient, surgical treatment including CC and/or focus resection /disconnection can cure ES. Surgery might be an acceptable option for medically intractable ES.  Funding: No funding