Abstracts

Epilepsy is a chronic conditions that affects all ages. A major proportion of patients falls in the pediatric group and 15 to 25% of them have medically intractable epilepsy. Patients with mental retardation, neurological abnormalities, symptomatic epilepsies, high seizure frequency from the beginning, past history of [italic]status epilepticus, [/italic]and whose seizures are not controlled by the first AED have al poor prognosis. Epilepsies in children are frequenly of extratemporal origin, usually associated to cortical developmental abnormalities (CDA), phakomatosis, Rasmussen[apos]s syndrome, tumors or birth trauma lesions. Some of these pediatric epilepsy syndromes carry a poor long-term prognosis but early surgical interventions may eventually change this [ldquo]natural[rdquo] evolution and improve prognosis. Post-operative seizure outcome is similar to that observed in adults, suggestting that surgical treatment should be considered for all patients with medically intractable epilepsy, independent of age. We analyzed 30 patients with medically intractable epilepsy operated on from July 1994 to December 2004, under five years, considering age at surgery, seizure type, pathological findings and seizure outcome. All data were prospectively collected, according to protocols previously approved by the institution ethics committee. 63.3% of patients were male. Mean epilepsy onset was 0.9 [plusmn] 1.3 years and age at surgery was 2.9 [plusmn] 1.5 years. Surgical procedures performed were hemispherectomies (30%), temporal lobectomy (23.3%), lesionectomies (16.7%), frontal lobectomy (13.3%), multilobar resections (13.3%) and calosotomy (3.3%).
Surgical specimens revealed CDA (40%), tuberous sclerosis (20%); porencephalic lesions (10%), tumors (6.7%), MTS (6.7%), Sturge Weber Syndrome (6.7%), Rasmussen Syndrome (3.3% of surgeries) and dual pathology (CDA and tumor, 3.3%). Post-operative seizure outcome showed Engel classification I (50%), II (10%), III (33.3%) and IV (6.7%). There was a correlation between completeteness of the resection and seizure outcome. Medically intractable epilepsies in infancy deserve special attention of pediatricians and epileptologists. In this age range, the most important argument for considering epilepsy surgery is the natural history of epilepsy syndromes. In this series we report on surgeries performed in very young children with overall good outcome (60% of patients with Engel I or II). In conclusion, surgical treatment of epilepsy in young children is an efficient therapy for medically intractable symptomatic epilepsies.