Epilepsy surgery is a successful treatment option in children suffering from intractable
focal epilepsy.
We report the biographical and clinical data as well as the postoperative seizure
outcome of 311 children who underwent epilepsy surgery for drug resistant focal epilepsy
between September 1st 1998 until November 30th 2010.
Methods: Retrospective analysis of the patients' database for demographical, clinical and
outcome parameters. As a minimum patients underwent prolonged EEG- Video- monitoring
with closely spaced electrodes and a very high resolution cranial MRI under general
anaesthesia. Minimum post operative follow up: 6 months. Average postoperative follow
up 5.5y.
Results:
Average age at onset of epilepsy: 3.2±3.8y, at operation 9.3±6.2y. Mental state (286 patients underwent an age-appropriate testing of mental development): normal intelligence 94 patients (33%), mental retardation 192 patients (67%): mild
to moderate 88 (31%), severe to profound 104 (36%). 25 foreign patients were not examined.
Epilepsy syndromes: 254 (82%) patients suffered from extratemporal, multilobar or hemispheric epilepsies
and 57 (18%) from pure temporal lobe epilepsies.
Etiology: focal cortical dysplasia: 140 patients (45%), gliotic- ischemic lesions: 61 (19,6%),
tumors: 52 (16,7%), hippocampal sclerosis: 15 (4,8%), phacomatosis: 14 (4,5%), polymicrogyria:
12 (3,9%), hemimegalencephaly: 4 (1,3%), Rasmussens E.: 4 (1,3%), vascular malformations:
2 (0,6%), miscellaneous: 7 (2,3%).
Outcome: 51% of patients were seizure free, 9% had auras only, 9% had a >90% seizure reduction,
11% had a >50% seizure reduction and 11% were unchanged. For 9% of the patients dates
for postoperative follow up are pending.
Conclusions: About 69% of the patients had a favourable seizure outcome. These results show that
epilepsy surgery in children is a very effective treatment option. Epilepsy surgery
offers a great chance even for a pediatric population with an overrepresentation of
severely retarded children and widespread epileptogenic lesions.
