title: Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings.
abstract: OBJECTIVE
  To understand the role of epilepsy surgery in children with generalized or bilateral findings on preoperative scalp EEG.
  
  
  METHODS
  From our pediatric epilepsy surgery series, we identified 50 patients in whom 30 to 100% of preoperative epileptiform discharges (ictal, interictal, or both) were generalized or contralateral to the side of surgery.
  
  
  RESULTS
  All patients had severe refractory epilepsy and an epileptogenic lesion on brain MRI. Ninety percent of the lesions were congenital, perinatal, or acquired during infancy, predominantly malformations of cortical development (44%) or cystic encephalomalacia (40%). Age at surgery was 0.2 to 24 (median 7.7) years. Surgeries were hemispherectomy (64%) or lobar or multilobar resection. At last follow-up (median 24.0 months), 72% of patients were seizure-free, 16% had marked improvement with only brief episodes of staring or tonic stiffening, and 12% were not improved. The rate of seizure-free outcome was not significantly associated with age at seizure onset or surgery, presence of hemiparesis or focal clinical features during seizures, type of lesion, or surgery type. Postoperative seizure-free rate did not differ from that in a comparison group of similar patients who matched the study group except for their high percentage (70 to 100%) of ipsilateral ictal and interictal epileptiform discharges on preoperative EEG.
  
  
  CONCLUSIONS
  Epilepsy surgery may be successful for selected children and adolescents with a congenital or early-acquired brain lesion, despite abundant generalized or bilateral epileptiform discharges on EEG. The diffuse EEG expression may be due to an interaction between the early lesion and the developing brain.
authors.affiliation: Department of Neurology and Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH 44195, USA. wylliee@ccf.org
authors.forename: E
authors.initials: E
authors.lastname: Wyllie
authors.forename: D K
authors.initials: DK
authors.lastname: Lachhwani
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: A
authors.initials: A
authors.lastname: Chirla
authors.forename: G
authors.initials: G
authors.lastname: Cosmo
authors.forename: S
authors.initials: S
authors.lastname: Worley
authors.forename: P
authors.initials: P
authors.lastname: Kotagal
authors.forename: P
authors.initials: P
authors.lastname: Ruggieri
authors.forename: W E
authors.initials: WE
authors.lastname: Bingaman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001921:Brain / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009421:Nervous System Malformations / Q000150:complications* / Q000503:physiopathology; D009434:Neural Pathways / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D016896:Treatment Outcome