Abstracts

Rationale: Approximately 22-28% of pediatric stroke patients develop epilepsy; however, medically refractory seizures in this population has not been well studied. Methods: Retrospective chart review of pediatric patients ( 18 years or younger) who underwent epilepsy surgery between 2007-2010 at the Cleveland Clinic with stroke as the underlying etiology for seizures. IRB approval was obtained. The diagnosis of stroke was confirmed by MRI and histologic findings. Results: 59 patients were identified. Sixty percent (36/59) were males. Forty-seven percent of strokes occurred in the perinatal period, with acute ischemic stroke being the most common etiology (78%). Risk factors for stroke were only identified in 44% of patients, with acute systemic illness being the most common. Multiple daily seizures occurred in 84% of patients. Mean age at surgery was 9.6 years with a median of 9.6 years. Functional hemispherectomy was the most common type of surgery (53%), followed by multilobar resection (17%). Sixty-seven percent of patients were seizure free at 12 months; of those who had recurrent seizures, 50% manifested within 2 weeks of surgery. Only significant predictors of failure after epilepsy surgery included a previous history of epilepsy surgery (27% seizure free) and presence of generalized interictal sharp waves (45% seizure free). Favorable candidates included ischemic stroke and severe deficit at time of surgery. Age, sex, side of surgery, age at surgery had no influence on outcome.Conclusions: Epilepsy surgery is effective in the treatment of refractory seizures following stroke in children (67% seizure free at 12 months). Patients with history of ischemic stroke and severe motor deficit at time of surgery tend to do better. Diffuse epileptiform EEG findings may not be a contraindication for successful surgery. Seizure outcome was not influenced by presence of contralateral sharp waves or EEG seizures. Surgical failures are likely to occur early. Surgical treatment of refractory epilepsy should be considered early in appropriate pediatric stroke patients. Successful seizure control could lead to reduced