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Year : 2011  |  Volume : 59  |  Issue : 1  |  Page : 30--36

Outcome of epilepsy surgery in children after evaluation with non-invasive protocol

1 Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
2 Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
3 Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
4 Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India

Correspondence Address:
Sita Jayalakshmi
Krishna Institute of Medical Sciences, 1-8-31/1, Minister Road, Secunderabad 500 003, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.76854

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Objective : To assess outcome of epilepsy surgery in children with medically refractory partial epilepsy evaluated with non-invasive protocol and to determine the predictors of outcome. Patients and Methods : Retrospective analysis of presurgical, surgical, and postsurgical data was performed in 87 children who had at least 1 year post surgery follow-up. Outcome was assessed according to Engel's outcome classification. Stepwise regression followed by logistic regression analysis was employed in data analysis. Results : Mean follow-up was 32 (12-58) months and 44 (50.6%) were males. The age of onset of epilepsy was below the age of 2 years in 24 (30.8%). Resective surgery was done in 78 children. The commonest surgery performed was a temporal resection (88.9%) in adolescents and an extra-temporal resection ( 60.6%) in children. The commonest pathology was hippocampal sclerosis (HS) in adolescents and developmental, tumoral lesions, and gliosis in children. At last follow-up, 50 (64.1%) were seizure free and Engel's favourable outcome was noted in 59 (75.6%). After stepwise regression analysis, variables found to be significant (P < 0.05) and predicting a favourable outcome were lesion on MRI, normal IQ, and partial seizures without secondary generalization. Bilateral spikes on interictal EEG and acute postoperative seizures were predictors of poor outcome. A regression model was developed; the sensitivity, specificity, accuracy, and area under ROC curve were 82%, 91%, 88.5%, and 0.97%, respectively. Conclusion : Favourable outcome after epilepsy surgery can be obtained in children with temporal lobe epilepsy with HS and lesion-related epilepsies in developing countries with limited resources, after evaluation with a non-invasive protocol.


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Online since 20th March '04
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