Lobar and multilobar resections for medically intractable pediatric epilepsy

Abstract

Pediatric epilepsy surgery patients are different than adult epilepsy surgery patients by having a higher proportion of extratemporal than temporal lobe lesions, and by having cortical dysplasia as the most frequent pathology. We analyzed 111 pediatric epilepsy patients who received lobar or multilobar resections at the University of California, Los Angeles, between the years 1986 and 2000 to determine if there were differences in seizure outcome by lobe of resection and tissue pathology. Results showed that temporal lobe resection patients had lower pre- and postoperative seizure frequencies compared with extratemporal single lobe resection patients (p < 0.05). Furthermore, single lobe resection patients from any brain region had lower pre- and postoperative seizure frequencies compared with multilobar resection patients (p < 0.05), an effect which was due to the better seizure outcomes in temporal lobe resection cases. Patients with mass lesions had the best postoperative seizure control, followed by cortical dysplasia patients and other pathologies (p < 0.05). In all patient groups, there was a significant reduction in pre- to postoperative seizure frequencies (p < 0.0001). These results indicate that postsurgery seizure outcomes in pediatric epilepsy surgery patients vary by lesion location and pathology, with the best outcomes in temporal lobe patients with mass lesions. However, surgical resections of epileptogenic lesions, regardless of lobe, were associated with significant postoperative improvements in seizure frequency.