title: Improved outcomes in pediatric epilepsy surgery: the UCLA experience, 1986-2008.
abstract: OBJECTIVE
  Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time.
  
  
  METHODS
  Pediatric epilepsy surgery patients operated in the first 11 years (1986-1997; pre-1997) were compared with the second 11 years (1998-2008; post-1997) for differences in presurgical and postsurgical variables.
  
  
  RESULTS
  Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, +16%), 1 (81%, +18%), 2 (77%, +19%), and 5 (74%, +29%) years, and more seizure-free patients were on medications at 0.5 (97%, +6%), 1 (88%, +9%), and 2 (76%, +29%), but not 5 (64%, +8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery.
  
  
  CONCLUSIONS
  Improved technology and surgical procedures along with changes in clinical practice were likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients.
authors.affiliation: Reed Neurological Research Center, 710 Westwood Plaza, Room 2123, Los Angeles, CA 90095-1769, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hemb
authors.forename: T R
authors.initials: TR
authors.lastname: Velasco
authors.forename: M S
authors.initials: MS
authors.lastname: Parnes
authors.forename: J Y
authors.initials: JY
authors.lastname: Wu
authors.forename: J T
authors.initials: JT
authors.lastname: Lerner
authors.forename: J H
authors.initials: JH
authors.lastname: Matsumoto
authors.forename: S
authors.initials: S
authors.lastname: Yudovin
authors.forename: W D
authors.initials: WD
authors.lastname: Shields
authors.forename: R
authors.initials: R
authors.lastname: Sankar
authors.forename: N
authors.initials: N
authors.lastname: Salamon
authors.forename: H V
authors.initials: HV
authors.lastname: Vinters
authors.forename: G W
authors.initials: GW
authors.lastname: Mathern
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D002140:California; D002648:Child; D004827:Epilepsy / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000379:methods*; D010372:Pediatrics; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants