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Journal of the Korean Child Neurology Society 2010;18(1):20-32.
Published online May 30, 2010.
Surgical Outcomes and Prognostic Factors after Epilepsy Surgery in Children with Extratemporal Lobe Epilepsy.
Kum Ok Choi, Hoon Chul Kang, Joon Soo Lee, Dong Seok Kim, Heung Dong Kim
1Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. hdkimmd@yuhs.ac
2Department of Neurosurgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea.
Abstract
PURPOSE
In this study, we reviewed surgical outcomes in children with extratemporal lobe epilepsy in our institution and suggested prognostic factors from these results. METHODS: We retrospectively analyzed the records of 59 patients(males n=35, females n=24; mean age of 10 years, mean age of seizure onset of 3 years, mean age of epilepsy surgery of 8 years) who received extratemporal lobe surgery between October 2003 to May 2008. Every patients were performed preoperative evaluation to determine the anatomical location of the ictal onset zone employing video electroencephalography(EEG) monitoring, intraoperative electrocorticography, intracranial EEG monitoring and neuroimagings such as Magnetic Resonance Imaging (MRI), positron emission tomography, interictal/ictal single photon emission computed tomography. Developmental test was taken at pre- and post-operation. RESULTS: Postoperative outcome as defined by Engel's classification were as follows; class I in 42(71.2%), II in 6(10.2%), III in 4(6.8%), and IV in 7(11.9%) patients. We considered six favorable prognostic factors from our data; age at operation, matching accuracy of video-EEG monitoring results, presence of a structural lesion on MRI, using specialized neuromodalities, involvement of lobe at surgery, and nature of the epileptogenic lesion. We also focused on unfavorable prognostic factors; no structural lesion on MRI, low grade of surgical pathology, postoperative epileptiform discharges on EEG. CONCLUSION: Early surgical intervention in pediatric patients with medically refractory seizure who possess focal epileptogenic foci of extratemporal lobe origin has been an effective and safe treatment.
Key Words: Epilepsy, Surgery, Child, Outcome assessment, Prognosis


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