Abstracts

Rationale: Although surgical resection for refractory epilepsy has become fairly common practice in the adult population, it is less well studied in the pediatric population. There are even fewer cases performed for extra-temporal epilepsy. Particularly, there are relatively few studies addressing the long-term outcomes of seizures, developmental growth, learning, and social interactions. Therefore, as there are long-term risks of anti-epileptic therapy and surgery is becoming a more viable option, there is great value in assessing seizure outcomes and long-term development in the pediatric population. Methods: This was a retrospective study, which included all extra-temporal resections performed in the pediatric population at the University of Michigan from 2000 to 2008. Data was collected by chart reviews and included the age of seizure onset, seizure pattern and frequency, ictal and interictal EEG pattern, MRI imaging, pathology, neuropsychiatric testing, speech and language evaluation, and long-term follow-up. Presurgical and postsurgical data was taken from the computerized database of subsequent clinic visits. Results: Eight patients underwent extra-temporal resection at the University of Michigan from 2000 to 2008. There were 5 females and 3 males between the ages of 27 months and 15 years. Average age of seizure onset was 43.0 months and patients had been tried on an average of 6 anti-epileptic medications. Areas of resection included frontal (4), parietal (2), parieto-temporal (1), and occipital (1) regions. 75% of patients were experiencing seizures daily. Post-operatively, 75% were seizure-free (Engel Class I) while 25% had a significant reduction of their seizure frequency (Engel class 3a). One patient underwent incomplete resection of cortical dysplasia due to the presence of eloquent cortex; the second patient had recurrent seizures 1-yr post-op when AEDs were tapered. Brain pathology included focal cortical dysplasia (6), vascular malformation (1), and neoplasm (1). Complications included formation of a pseudomeningocele requiring drainage 18 days post-operatively. Conclusions: The majority of patients that underwent extra-temporal resection became seizure-free and reported significant improvement in cognition and learning (including the ones who did not become seizure free). In particular, there were excellent outcomes in seizure reduction in patients with extra-temporal cortical dysplasia. Our success rate of seizure-free patients was higher than the average reported in the literature for the pediatric patients with extra-temporal epilepsy. Based on our data, there is potential for significant reduction in seizure frequency and overall improvement in the quality of life of these patients, even in patients that do not achieve seizure freedom. This should encourage early and aggressive work-up for extra-temporal surgical resection in the pediatric population. However, more studies with larger sample sizes should be performed to further illustrate this.