SEIZURE OUTCOME AFTER EPILEPSY SURGERY IN CHILDREN AND ADOLESCENTS

Few epilepsy surgery outcome data are available from series of pediatr ic patients. We studied seizure outcome in 136 pediatric patients who had surgery for intractable epilepsy at The Cleveland Clinic between J anuary 1990 and June 1996, with a postoperative follow-up of 1 to 7.5 years (mean, 3.6 years). Sixty-two children (3 months to 12 years old at time of surgery) were compared with 74 adolescents (13-20 years old ). Extratemporal or multilobar resections and hemispherectomies were s imilarly frequent among children (50%) and adolescents (44%), but thes e procedures strongly predominated in infancy (90% of patients 0-2 yea rs of age). The remaining patients had temporal resection. Cortical dy splasia and low-grade tumor were the most common causes and hippocampa l sclerosis was rare. Seizure-free outcome was achieved for 69% of ado lescents, 68% of children, and 60% of the infant subgroup, overall; fo r 23 (74%) of 31 children and 33 (80%) of 41 adolescents after tempora l resection; for 11 (58%) of 19 children and 15 (52%) of 29 adolescent s after extratemporal or multilobar resection; and for 8 (67%) of 12 c hildren and 3 (75%) of 4 adolescents after functional hemispherectomy. Seizure-free outcome was more frequent after temporal resection (56 o f 72, 78%) than after extratemporal or multilobar resection (26 of 48, 54%; 41 of 48 with a focal lesion on magnetic resonance imaging), and among patients with tumor (36 of 44, 82%) versus cortical dysplasia ( 16 of 31, 52%). The frequency of seizure-free outcome after epilepsy s urgery was similar for infants, children, and adolescents, and compara ble with results from adult series. Most patients in each age, surgery type, and causal group were free from seizures after surgery. These r esults suggest that children should be considered for surgical evaluat ion at whatever age they manifest with severe, intractable, disabling localization-related epilepsy.