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Journal of the Korean Child Neurology Society 2006;14(1):45-58.
Published online May 30, 2006.
Surgical Experiences on a Case by Case Basis for Intractable Childhood Epilepsy.
Yong Joo Kim, Yong Soon Hwang, Su Jeong You, Hoon Chul Kang, Sang Keun Park, Tae Sung Ko
1Department of Pediatric, Epilepsy Center, Sanggye Paik Hospital, Inje University College of Medicine, Korea. hipo0207@sanggyepaik.ac.kr
2Department of Neurosurgery, Epilepsy Center, Sanggye Paik Hospital, Inje University College of Medicine, Korea.
3Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
Abstract
PURPOSE
This study aimed to reveal the benefits and the safety of surgical treatment in children with refractory epilepsy by reviewing our experiences on a case-by-case basis. METHODS: Twenty one patients who underwent epilepsy surgeries from September, 2003 to March, 2005 at Sanggye Paik Hospital were included. Data including clinical features and surgical outcomes were filed up through 2 years. RESULTS: The profiles of the 15 patients who underwent curative epilepsy surgeries were as follows. Characteristically, one patient had dual epilepsy including mesial temporal lobe epilepsy. Two patients had infantile spasms with cortical dysplasia, both of whom underwent epilepsy surgeries in early infancy. Also, there is a patient who underwent a re-operation, while another one patient had an epileptic focus in the insular lobe. Two patients were diagnosed Sturge-Weber syndrome, and three patients had nonlesional or lesional multilobar epilepsies. Furthermore, the surgical outcomes can be classified such as Engel class I in 10(66.7%) patients, class II in 3(20.0%) patients while one patient failed to obtain any seizure reduction after surgical treatment. In addition, palliative total corpus callosotomies were tried in 6 patients. But only one patient showed seizure reduction of more than 90%, while 4 patients exhibited 50-75% seizure reduction and the other one did not have any changes in seizure frequency. We also experienced various kinds of unwanted events such as memory deterioration (1), vascular infarction (1), hypoxic insult (1), transient hemiparesis (2), dysinhibition (1) and visual field defects (3). Most of neuroimaging studies were highly concordant to the ictal scalp and intracranial EEGs. CONCLUSION: Epilepsy surgery can be an effective therapeutic modality in localization related intractable childhood epilepsies. However, we should consider various surgical complications and carefully evaluate the epileptogenic and functionally eloquent areas.
Key Words: Epilepsy surgery, Intractable childhood epilepsy


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