Abstracts

Rationale: Patients with drug-resistant epilepsy (DRE) are considered for surgical intervention.¹ Surgical interventions for DRE can be divided into two broad categories: curative and palliative. Curative epilepsy surgeries involve successful identification and removal of the ictal onset zones by means of lesionectomy, corticectomy, lobectomy, or hemispherectomy. Interstitial laser ablation is an option for focal, relatively isolated lesions of appropriate size. Alternatively, in situations that curative surgical interventions are not a viable option, palliative surgical intervention is considered.² Curative surgical interventions may be more intricate in pediatric patients than in adults due to the additional surgical considerations, more dynamic nervous system, neuropsychological considerations, and plasticity.^1,3 Curative interventions are shown to have a higher likelihood of including extratemporal resections and hemispherectomies than in adult patients.⁴  The desired outcome of this project is to better understand the focal distribution of curative surgical interventions in DRE pediatric patients.

Methods: The Epilepsy database was retrospectively reviewed for all patients at Dell Children’s Medical Center (DCMC) who had prior neocortical resection to treat drug-resistant epileptic seizures between 2017 and 2021. These cases were then categorized based on the focal distribution of potential curative surgical intervention.

Results: From 2017-2021, 123 pediatric patients underwent surgical resections/ablations. Most other surgical procedures were done in patients with multifocal, generalized or epileptic encephalopathies (115 devices were placed and 22 Corpus Callosotomies). Out of the 123 surgical resections/ablations to treat DRE pediatric patients at DCMC: _x000D_ _x000D_ 34 had Frontal Lobe Resections _x000D_ 32 had Temporal Lobe Resections_x000D_ 5 had Parietal Lobe Resections _x000D_ 4 had Occipital Lobe Resections_x000D_ 23 had Multiple Lobar Resections _x000D_ 10 had resections in other areas of the brain_x000D_ _x000D_ Conclusions: This study revealed that out of the 123 DRE pediatric patients at DCMC that underwent surgical resections from 2017-2021, 27.6% were frontal resections, 26.01% were temporal resections, 4% were parietal resections, 4% were occipital resections, 10.5% hemispherectomies, 19.5% involved two or more lobes, and 8.1% were isolated procedures of other areas of the brain. Ongoing analysis will compare demographic and epilepsy/seizure-related factors of 4 sub-divided groups (mesial temporal epilepsy vs neocortical temporal vs frontal vs other focal epilepsies).

Funding: The Loretta and Jeff Clarke Foundation