Background: Seizure freedom, decreased burden of antiseizure medications and improvement in neurodevelopmental,
cognitive, and motor decline can be achieved via epilepsy surgery in patients with
structural drug-resistant epilepsy (DRE).
Aims and Objectives: To describe clinical-etiologic, seizure freedom and the long-term functional outcomes
(at least 5-year follow-up) in children ≤18 years who underwent epilepsy surgery between
January 2004 and December 2016.
Methods: Preoperative clinical, electroencephalography (EEG), imaging, and surgical data were
collected from retrospective chart review. A structured questionnaire was used to
assess postoperative functional outcomes. International League Against Epilepsy (ILAE)
epilepsy surgery outcome classification was used for postoperative seizure outcome.
Results: Seventy-five children (male:female 1.2:1) had onset of epilepsy and underwent epilepsy
surgery at median age of 30 months and 9.6 years respectively. Perinatal insults (hypoglycemia,
asphyxia, stroke; n = 18,21.3%) followed by malformations of cortical development (n = 15, 20%) constituted major etiologies. Surgical procedures performed were: Peri-insular
hemispherotomy (n = 35, 46.6%), anterior temporal lobectomy with amygdalohippocampectomy (n = 23,30.6%), posterior quadrantectomy (n = 9, 12%), lesionectomy/lobectomy (n = 7, 9.3%), and cyst fenestration (n = 1, 1.3%). Fifty-five (73.3%) patients were either completely seizure-free or had
only auras up to 3 seizure days per year. Sixty-four (87.7%) patients walked independently.
Nine (12%) patients developed new visual symptoms postoperatively. Fifty-six (76.7%)
and 43 (58.89%) children had satisfactory spoken language skills and reading skills,
respectively. Significant behavioral problems were reported in 16 patients (21.92%).
Two patients succumbed due to persistent seizures and probable aspiration pneumonitis
at home.
Conclusion: Epilepsy surgery achieves long-term seizure freedom and functional outcomes in structural
DRE.
