title: Is postresective intraoperative electrocorticography predictive of seizure outcomes in children?
abstract: OBJECTIVE
  Intraoperative electrocorticography (ECoG) is commonly used to guide the extent of resection, especially in lesion-associated intractable epilepsy. Interictal epileptiform discharges on postresective ECoG (post-ECoG) have been predictive of seizure recurrence in some studies, particularly in adults undergoing medial temporal lobectomy, frontal lesionectomy, or low-grade glioma resection. The predictive value of postresective discharges in pediatric epilepsy surgery has not been extensively studied.
  
  
  METHODS
  The authors retrospectively examined the charts of all 52 pediatric patients who had undergone surgery with post-ECoG and had more than 1 year of follow-up between October 1, 2003, and October 1, 2009.
  
  
  RESULTS
  Of the 52 pediatric patients, 37 patients showed residual discharges at the end of their resection and 73% of these patients were seizure free, whereas 15 patients had no residual discharges and 60% of them were seizure-free, which was not significantly different (p = 0.36, chi-square).
  
  
  CONCLUSIONS
  Electrocorticography-guided surgery was associated with excellent postsurgical outcome. Although this sample size was too small to detect a subtle difference, absence of epileptiform discharges on post-ECoG does not appear to predict seizure freedom in all pediatric patients referred for epilepsy surgery. Future studies with larger study samples would be necessary to confirm this finding and determine whether post-ECoG may be useful in some subsets of pediatric epilepsy surgery candidates.
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA, USA. carterwraymd@gmail.com
authors.forename: Carter D
authors.initials: CD
authors.lastname: Wray
authors.forename: Sharon S
authors.initials: SS
authors.lastname: McDaniel
authors.forename: Russell P
authors.initials: RP
authors.lastname: Saneto
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Novotny
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Ojemann
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000150:complications / Q000601:surgery; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D018303:Ganglioglioma / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome