title: Outcome of surgical treatment in non-lesional intractable childhood epilepsy.
abstract: OBJECTIVE
  The aim of this study is to investigate seizure outcomes following epilepsy surgery in non-lesional neocortical pediatric epilepsy.
  
  
  METHODS
  We performed a retrospective study on 27 patients with intractable childhood epilepsy who received epilepsy surgery between 1999 and 2006 at Sang-gye Paik Hospital and Severance Children's Hospital. None of the patients had any detectable lesions on MRI. Surgical outcome was assessed at least 2 years postoperatively; clinical characteristics, surgical outcome, pathologic findings, types of surgery, localizing features on SPECT, FDG-PET, and long-term video-EEG were reviewed.
  
  
  RESULTS
  Eighteen patients (67%) demonstrated an Engel class I outcome postoperatively. The mean follow-up duration was 4.3 years (range, 2.2-9 years). Eighteen out of 27 cases (67%) showed focal localizing features on ictal SPECT, and 21 of 27 cases (78%) showed abnormal findings on PET. Single lobectomy was the most common procedure, and was performed in 20 patients (74%). Multilobar resection was performed in seven patients (26%). Cortical dysplasia was the most common finding during pathological examination, and was observed in 15 (56%) cases. In addition, gliosis was found in two patients (7%) and non-specific pathological findings were described in 10 patients (37%).
  
  
  CONCLUSIONS
  In children with intractable epilepsy and a MRI demonstrating no abnormal lesions, epileptic surgery should be strongly considered when cortical pathology can be identified from other studies.
authors.affiliation: Department of Pediatrics, Institute for Handicapped Children, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Joo Hee
authors.initials: JH
authors.lastname: Seo
authors.forename: Byoung Ho
authors.initials: BH
authors.lastname: Noh
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Dong Suk
authors.initials: DS
authors.lastname: Kim
authors.forename: Seung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Tae Seung
authors.initials: TS
authors.lastname: Kim
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Hoon Chul
authors.initials: HC
authors.lastname: Kang
authors.forename: Heung Dong
authors.initials: HD
authors.lastname: Kim
mesh_terms: D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome