Postoperative seizure control and antiepileptic drug use in pediatric epilepsy surgery patients: The UCLA experience, 1986-1997

Purpose: Young children with refractory symptomatic epilepsy are at risk fo r developing neurologic and cognitive disabilities. Stopping the seizures m ay prevent these disabilities, but it is unclear whether resective surgery is associated with adequate long-term seizure control. Methods: This study determined pre- and postsurgery seizure frequency and a ntiepileptic drug (AED) use (6 months to 10 years) in children with symptom atic seizures from unilateral cortical dysplasia (CD; n = 64) and non-CD et iologies (i.e., ischemia, infection; n = 71), and compared them with older temporal lobe epilepsy (TLE; n = 31) patients with complex partial seizures . Results: Compared with presurgery, postsurgery seizure frequencies were dec reased for CD, non-CD, and TLE patients (p < 0.002), and there were no diff erences between the three groups from 6 to 24 months after surgery (p > 0.1 2). At 5 years after surgery, seizure frequencies were greater in CD compar ed with TLE cases (p = 0.009). Compared with presurgery, the number of AEDs declined after surgery in all three groups (p < 0.002), and positively cor related with seizure frequencies (p = 0.0001). Conclusions: This study indicates that seizure relief and AED use after res ective surgery for symptomatic CD and non-CD etiologies was comparable with complex partial TLE cases up to 2 years after surgery. Furthermore, at 5 y ears after surgery, CD patients had outcomes better than those before surge ry, but worse than TLE cases. In young children, these findings support the concept that early removal of symptomatic pathologic substrates is associa ted with seizure control and reduced AED use, similar to that noted in olde r TLE cases up to 2 years after surgery. Seizure control may reduce the ris k of developing the seizure-related encephalopathy associated with severe s ymptomatic early-onset childhood epilepsy.