title: Resective pediatric epilepsy surgery in Lennox-Gastaut syndrome.
abstract: OBJECTIVE
  The objective of this study was to evaluate the role of resective pediatric epilepsy surgery for Lennox-Gastaut syndrome (LGS).
  
  
  METHODS
  We analyzed clinical data of 27 children and adolescents who had LGS and underwent resective epilepsy surgery despite abundant (>30% of preoperative interictal and/or ictal epileptiform discharges) generalized or generalized contralateral maximal and multiregional electroencephalogram abnormalities.
  
  
  RESULTS
  On high-resolution MRI, cerebral lesions were noted in 23 (85.2%) patients but not in 4 (14.8%) patients. The age of patients at the time of surgery was between 1.7 and 17.3 years (mean: 7.8 years). Surgeries were lobar or multilobar resection in 21 (77.8%) patients and hemispherotomy in 6 (22.2%). At a mean of 33.1 months' postoperative follow-up, 16 (59.3%) patients had no seizures and 4 (14.8%) had infrequent seizures. Of 4 patients without brain abnormalities found on MRI, 2 patients became seizure-free after resective surgery was performed on the basis of electrophysiologic studies and concordant results in other multimodal neuroimages. Malformation of cortical development was the most common pathology and was seen in 20 (74.1%) patients, but 2 (7.4% patients) did not show any abnormal pathology. Sixteen (72.7%) patients, including 14 who had no seizures and 2 who had infrequent seizures after surgery, showed an increase in developmental quotient. No clinical profile was significantly associated with postoperative seizure-free rate.
  
  
  CONCLUSIONS
  Resective epilepsy surgery should be considered for children with LGS, despite abundant generalized and multiregional electroencephalogram abnormalities.
authors.affiliation: Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
authors.forename: Yun Jin
authors.initials: YJ
authors.lastname: Lee
authors.forename: Hoon-Chul
authors.initials: HC
authors.lastname: Kang
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Shin Hye
authors.initials: SH
authors.lastname: Kim
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
authors.forename: Yun-Ho
authors.initials: YH
authors.lastname: Lee
authors.forename: Tae Seung
authors.initials: TS
authors.lastname: Kim
authors.forename: Heung Dong
authors.initials: HD
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013577:Syndrome; D016896:Treatment Outcome