title: Epilepsy surgery in children: results and predictors of outcome on seizures.
abstract: OBJECTIVE
  To retrospectively analyze the results on seizures of surgery in children with drug-resistant focal epilepsy. To identify the factors predicting seizure control among several presurgical, surgical, and postsurgical variables.
  
  
  METHODS
  One hundred thirteen patients (67 male, 46 female), younger than 16 years, operated on from 1996 to 2004 and followed-up for at least 2 years were identified. Individualized microsurgical resections, aimed at removal of the epileptogenic zone, were performed according to the results of tailored presurgical evaluations, which included stereo-electroencephalographic recording with intracerebral electrodes when needed. Risk of seizure recurrence was assessed for the considered variables by bivariate and multivariate analysis.
  
  
  RESULTS
  Mean age at surgery was 8.8 years, mean duration of epilepsy was 5.7 years, and mean age at seizure onset was 3.1 years. One hundred eight patients (96%) had an abnormal magnetic resonance imaging. At postoperative follow-up (mean duration 55.1 month), 77 patients (68%) were in Engel's class I, with 68 patients (60%) being seizure free (Engel's classes Ia and Ic). At multivariate analysis, variables associated with a significantly lower risk of seizure recurrence were unifocal lesion at MRI and older age at seizure onset (presurgical variables), temporal unilobar resection and complete lesionectomy (surgical variables), diagnosis of glial-neuronal tumors (postsurgical variables).
  
  
  CONCLUSIONS
  Surgery is a valuable option for children with drug-resistant focal epilepsies which may provide excellent results in a considerable amount of cases. Since results of surgery for epilepsy strongly depend on the presurgical identification of the Epileptogenic Zone, future work should be focused on refinement and implementation of diagnostic strategies.
authors.affiliation: C. Munari, Center for Epilepsy Surgery, Ospedale Niguarda, Milan, Italy. massimo.cossu@ospedaleniguarda.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lo Russo
authors.forename: Stefano
authors.initials: S
authors.lastname: Francione
authors.forename: Roberto
authors.initials: R
authors.lastname: Mai
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
authors.forename: Ivana
authors.initials: I
authors.lastname: Sartori
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.forename: Alberto
authors.initials: A
authors.lastname: Citterio
authors.forename: Nadia
authors.initials: N
authors.lastname: Colombo
authors.forename: Manuela
authors.initials: M
authors.lastname: Bramerio
authors.forename: Carlo
authors.initials: C
authors.lastname: Galli
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D038481:Anterior Temporal Lobectomy; D002540:Cerebral Cortex / Q000002:abnormalities / Q000601:surgery; D002648:Child; D018572:Disease-Free Survival; D004351:Drug Resistance; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D015999:Multivariate Analysis; D011300:Preoperative Care; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013238:Stereotaxic Techniques; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome