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Journal of the Korean Child Neurology Society 2003;11(1):100-110.
Published online May 30, 2003.
Clinical Manifestations and Surgical Outcome of Medically Refractory Epilepsy in Childhood.
Ho Young Lee, Jeong Mi Cheon, So Hee Chung, Munhyang Lee, Seo Dae Won, Seung Bong Hong, Seung Chul Hong, Hye Kyung Yoon
1Department of Pediatrics, College of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea. mhlee@smc.samsung.co.kr
2Department of Neurology, College of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea.
3Department of Neurosurgery, College of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea.
4Department of Radiology, College of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea.
Abstract
PURPOSE
The cognitive and psychosocial morbidity of medically refractory epilepsy is considerable. Epilepsy surgery can play a important role in these patients. We investigated the clinical manifestations and the surgical outcome of our patients with medically refractory epilepsy. METHODS: We studied 27 patients under 15 years old who had epilepsy surgery at Samsung Medical Center between March 1995 and December 2001 retrospectively. RESULTS: The median age at first unprovoked seizure was 6 years, the median age at surgery was 11.02 years and duration of follow-up was 14 months to 7 years 2 months. Complex partial seizure was the most common type of seizures. Interictal and ictal discharges were lateralized in 66.7% and 81.5%, respectively. MRI showed abnormal findings in 23 patients and the cortical dysplasia was the most common pathologic finding. As per surgical outcomes, 77.8% of the patients became seizure free. Among patients with temporal lobe epilepsy(TLE), seizure free rate was 92.3% whereas patients with extratemporal lobe epilepsy(ETLE) showed 64.3% seizure free rate. All patients with TLE with focal lesions became seizure free. Patients with focal lesions which were concordant with findings of EEG, SPECT, and PET showed excellent surgical outcomes. However, patients with no focal lesion in MRI and discordant preoperative examinations showed poor outcomes. CONCLUSION: The results of epilepsy surgery in our patients were quite satisfactory. Good surgical outcome can be expected when the decision of surgery is made based on a good correlation among clinical, neuroradiological, and other preoperative examinations.
Key Words: Refractory epilepsy, Epilepsy surgery, Surgical outcome, Children


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