title: Outcome of epilepsy surgery in children after evaluation with non-invasive protocol.
abstract: OBJECTIVE
  To assess outcome of epilepsy surgery in children with medically refractory partial epilepsy evaluated with non-invasive protocol and to determine the predictors of outcome.
  
  
  METHODS
  Retrospective analysis of presurgical, surgical, and postsurgical data was performed in 87 children who had at least 1 year post surgery follow-up. Outcome was assessed according to Engel's outcome classification. Stepwise regression followed by logistic regression analysis was employed in data analysis.
  
  
  RESULTS
  Mean follow-up was 32 (12-58) months and 44 (50.6%) were males. The age of onset of epilepsy was below the age of 2 years in 24 (30.8%). Resective surgery was done in 78 children. The commonest surgery performed was a temporal resection (88.9%) in adolescents and an extra-temporal resection ( 60.6%) in children. The commonest pathology was hippocampal sclerosis (HS) in adolescents and developmental, tumoral lesions, and gliosis in children. At last follow-up, 50 (64.1%) were seizure free and Engel's favourable outcome was noted in 59 (75.6%). After stepwise regression analysis, variables found to be significant (P < 0.05) and predicting a favourable outcome were lesion on MRI, normal IQ, and partial seizures without secondary generalization. Bilateral spikes on interictal EEG and acute postoperative seizures were predictors of poor outcome. A regression model was developed; the sensitivity, specificity, accuracy, and area under ROC curve were 82%, 91%, 88.5%, and 0.97%, respectively.
  
  
  CONCLUSIONS
  Favourable outcome after epilepsy surgery can be obtained in children with temporal lobe epilepsy with HS and lesion-related epilepsies in developing countries with limited resources, after evaluation with a non-invasive protocol.
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. sita_js@hotmail.com
authors.forename: Sita
authors.initials: S
authors.lastname: Jayalakshmi
authors.forename: Manas
authors.initials: M
authors.lastname: Panigrahi
authors.forename: Dilip Kumar
authors.initials: DK
authors.lastname: Kulkarni
authors.forename: Megha
authors.initials: M
authors.lastname: Uppin
authors.forename: Shanmukhi
authors.initials: S
authors.lastname: Somayajula
authors.forename: Sundaram
authors.initials: S
authors.lastname: Challa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009493:Neurosurgery; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014741:Video Recording / Q000379:methods