title: Surgical treatment for localization-related infantile spasms: excellent long-term outcomes.
abstract: OBJECTIVE
  Focal epileptogenic lesions can manifest as infantile spasms, a catastrophic type of epilepsy. Although early surgery for catastrophic epilepsies has shown positive effects, little is known regarding long-term outcomes. The present study examined long-term outcomes in patients with localization-related infantile spasms treated surgically.
  
  
  METHODS
  Data from localization-related infantile spasm cases treated surgically between 1998 and 2002 at the Asan Medical Center were retrospectively reviewed. Presurgical evaluation, surgery, postoperative seizure frequency and developmental outcome data were analyzed.
  
  
  RESULTS
  Five patients met the inclusion criteria, and had etiologies of tuberous sclerosis, fetal infection, encephalomalacia, malformation of cortical development and low-grade astrocytoma, respectively. The mean seizure onset age was 5.4 months (range, 3 days to 11 months), and the mean age at surgery was 19 months (range, 9-29 months). Two patients underwent a functional hemispherectomy, and the remaining three underwent lesionectomy or temporal lobectomy. The follow-up duration was 6-9 years. We found that following surgery, 4 of the 5 patients were seizure-free at the final follow-up. The 2 patients with low grade astrocytoma and cortical dysplasia, respectively showed relatively good developmental outcomes.
  
  
  CONCLUSIONS
  Surgery may be an excellent option for treating selected patients with infantile spasms due to unilateral or focal congenital or early-acquired cortical lesions. However, developmental outcomes appear to be strongly linked to etiology and the pre-operative developmental level.
authors.affiliation: Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Mi-Sun
authors.initials: MS
authors.lastname: Yum
authors.forename: Tae-Sung
authors.initials: TS
authors.lastname: Ko
authors.forename: Jung Kyo
authors.initials: JK
authors.lastname: Lee
authors.forename: Seokho
authors.initials: S
authors.lastname: Hong
authors.forename: Deok Soo
authors.initials: DS
authors.lastname: Kim
authors.forename: Jeongho
authors.initials: J
authors.lastname: Kim
mesh_terms: D038481:Anterior Temporal Lobectomy; D000927:Anticonvulsants / Q000627:therapeutic use; D001254:Astrocytoma / Q000601:surgery; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000601:surgery; D004351:Drug Resistance; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D012640:Seizures / Q000453:epidemiology; D013036:Spasms, Infantile / Q000601:surgery*; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications / Q000601:surgery
chemical_list: D000927:Anticonvulsants