Abstracts

Little data are available on the effect and methods of surgical treatment in epilepsy with continuous spike-waves during slow-wave sleep (ECSWS) ECSWS diagnosis was based on continous spike-wave activity occupying at least 85% of non-REM sleep observed on overnight video-EEG in children with epileptic seizures and developmental regression. During 1991-2000 we diagnosed 37 children with ECSWS, seven of whom were selected for surgical treatment. The most common seizure types were atypical absences (five children had recurrent absence status), psychomotor and clonic seizures. MRI revealed polymicrogyria in three children (one unilateral) and changes consistent with peri [ndash] or postnatal vascular accidents in four. Video-EEG and MEG showed lateralized or multifocal epileptiform activity during wakefulness with propagation of epileptic discharges from one hemisphere to the other during seizures and sleep in all children. Age at surgery varied between 4.1-9.9 (median, 8.3) years. Four children underwent anterior callosotomy, one total callosotomy, one hemispherotomy and one parieto-occipital resection. Outcome was assessed at two years postoperatively. One child became seizure-free after hemispherotomy. Atypical absences disappeared in three children and were reduced over 80% in two. Further cognitive deterioration was halted in all children. Surgical treatment reducing transcallosal propagation of seizure activity may be beneficial in children with medically intractable ECSWS.