Surgery Outcome And Its Prognostic Factors In Child Epilepsy With Magnetic Resonance Imaging-Positive

Objective： To investigate the surgery outcome of children epilepsy withmagnetic resonance imaging(MRI)-positive，and prognostic factors in the surgery．Methods： Retrospective analysis was done upon58epilepsy children withMRI－positive who were operated and followed up for at least1year from Jun．2005to Sep．2009．The epileptogenic zone and the surgery programs were determinedaccording to the results of presurgical evaluations，which included video-electro-encephalogram(VEEG)，MRI，positron emission tomography and computedtomography(PET-CT)，and invasive EEG(IEEG).Surgical resections were aimed attotal removal of the epileptogenic zone and the lesions．Patients were categorized asseizure free group (Engel class Ⅰ) or seizure attack group (Engel classes Ⅱ-Ⅳ)after surgery． Statistical analysis was used for the predictable prognostic factors ofthe surgery which included age at surgery，epilepsy duration，age at epilepsy onset，seizure types， seizure frequency，epileptogenic zone and VEEG/MRI concordance．Results: According to the Engel classification，39cases (67.2%) of thechildren were seizure free after surgery，including17cases (73.9%) of temporal lobeatrophy or hippocampal sclerosis，11cases (91.7%) of low grade tumors，4cases(66.7%) of arachnoid cyst，3cases (42.9%) of cortical dysplasia，2cases(100%) ofcavernous hemangioma and2cases (25.0%) of malacia． Among19cases withseizure attacks after surgery，4cases(6.9%) were in Engel classⅡ，7cases(12.1%)werein Engel class Ⅲ，and8cases(13.8%) were in Engel class Ⅳ．The shorterepilepsy duration,low seizure frequency，not secondary generalized seizures andVEEG/MRI concordance were the strongest prognostic factors for favorable surgeryoutcome．Age at surgery，age at epilepsy onset，epileptogenic zone had no significantcorrelation with the surgery outcome． Conclusions: Surgery is effective and should be done early for childhoodepilepsy with MRI-positive．The surgery outcome can be predicted according toclinical factors and various diagnostic outcomes during the surgical treatment．...