Seizure outcomes in children with epilepsy after resective brain surgery

• Resective brain surgery is a suitable option for some children with epilepsy.
• We report an Engel Class 1 seizure outcome in 76% of 55 children with epilepsy after resective brain surgery.
• Resective brain surgery should be considered early in children with tumours and epilepsy.
• Intraoperative ECoG is useful to tailor the cortical resection in children with epilepsy having surgery.

PurposeTo assess the role of resective brain surgery in childhood epilepsy.MethodologyWe retrospectively analysed the seizure outcomes in 55 children with epilepsy who had resective brain surgery between 1997 and 2012, at our centre. The children were 1.5–18 years at the time of surgery; their seizure onset was between 0.2 andto 15 years of age. 48 had refractory epilepsy. One child died of tumour progression. Follow-up duration in the survivors ranged from 2 to −16 years (mean: 9).Presurgical evaluation included clinical profiles, non-invasive V-EEG monitoring, neuroimaging with MRIs in all; SPECT and PET in selected patients. 54 had intraoperative ECoG.ResultsAn Engel Class 1 outcome was seen in 78% of the cohort, with 67% being off all AEDs at the most recent follow-up. Children with tumours constituted the majority (56%), with 87% of this group showing a Class 1 outcome and 84% being off AEDs. Children with cortical dysplasia had a Class 1 outcome in 56%.ConclusionResective brain surgery is an efficacious option in some children with epilepsy. We found ECoG useful to tailor the cortical resection and in our opinion ECoG contributed to the good seizure outcomes.