Surgical outcome of extratemporal lobe epilepsy

Abstract

Introduction: The surgical treatment of intractable epilepsies is increasing steadily. In pediatric epilepsy the most origins of seizure are extratemporal, multiple, and diffuse area. The position of temporal lobe in pediatric epilepsy is relatively low. The purpose of this study was to discuss about the surgical outcome of the extratemporal lobe epilepsy in pediatric patients. Material and Methods: Patients who received epilepsy surgery from Mar 2003 to Mar 2009 were 263 cases in our department. Among 263 patients we analyzed 191 patients. Clinical feature, EEG, FDG-PET scan, SPECT, and MRI were analyzed. And then, the surgical outcome were analyzed each group and compared the results. Also the surgical outcome after definitive surgery will be analyzed.Results: There were 114 males and 77 females. The mean age at operation was 8.59 year-old (range; 2 month ~ 28 years old). The mean duration of seizure was 5.25 years (range; 21 days ~ 21 years). Most common preoperative diagnosis was Lennox-Gastaut syndrome. Others were infantile spasm, frontal lobe epilepsy, and cortical dysplasia. There were many types of seizure and many patients had multiple type of seizure. The most common type of seizure is complex partial seizure (CPZ). 47 patients had CPZ and other type of seizure. Pathological diagnosis was also made. Most common pathologic diagnosis was cortical dysplasia which reported 40 cases. The seizure outcome was evaluated at immediate postoperative period and at least 6 months after operation. The mean follow-up period was 36.16 month (range; 2~ 86.3 months). The seizure outcome was 114 patients in Engel Class 1 (60%), 44 in Class 2 (23%), 23 in Class 3 (12%), and 10 in Class 4 (5%). Total 158 patients (82.7%) showed favorable outcome after definitive surgery. There were several surgery-related complications such as 3 epidural hematomas, 17 subdural hematomas. 1 subdural hematoma was needed to be removed emergently due to the intolerance of patient.Conclusion: Extratemporal lobe epilepsy in pediatric patient is most challenging than other epilepsy. The localization of epileptic foci would be extremely important because only the total removal of epileptic focus or isolation from normal functioning brain will guarantee the seizure freedom. The aggressive localization of seizure focus and active removal of it could make the epilepsy patient free from seizure.