title: Neurosurgical management of frontal lobe epilepsy in children.
abstract: OBJECTIVE
  Pediatric frontal lobe epilepsy (FLE) remains a challenging condition for neurosurgeons and epileptologists to manage. Postoperative seizure outcomes remain far inferior to those observed in temporal lobe epilepsies, possibly due to inherent difficulties in delineating and subsequently completely resecting responsible epileptogenic regions. In this study, the authors review their institutional experience with the surgical management of FLE and attempt to find predictors that may help to improve seizure outcome in this population.
  
  
  METHODS
  All surgically treated cases of intractable FLE from 1990 to 2008 were reviewed. Demographic information, preoperative and intraoperative imaging and electrophysiological investigations, and follow-up seizure outcome were assessed. Inferential statistics were performed to look for potential predictors of seizure outcome.
  
  
  RESULTS
  Forty patients (20 male, 20 female) underwent surgical management of FLE during the study period. Patients were an average of 5.6 years old at the time of FLE onset and 11.7 years at the time of surgery; patients were followed for a mean of 40.25 months. Most patients displayed typical FLE semiology. Twenty-eight patients had discrete lesions identified on MRI. Eight patients underwent 2 operations. Cortical dysplasia was the most common pathological diagnosis. Engel Class I outcome was obtained in 25 patients (62.5%), while Engel Class II outcome was observed in 5 patients (12.5%). No statistically significant predictors of outcome were found.
  
  
  CONCLUSIONS
  Control of FLE remains a challenging problem. Favorable seizure outcome, obtained in 62% of patients in this series, is still not as easily obtained in FLE as it is in temporal lobe epilepsy. While no statistically significant predictors of seizure outcome were revealed in this study, patients with FLE continue to require extensive workup and investigation to arrive at a logical and comprehensive neurosurgical treatment plan. Future studies with improved neuroimaging and advanced invasive monitoring strategies may well help define factors for success in this form of epilepsy that is difficult to control.
authors: Divisions of Pediatric Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
authors: Shobhan
authors: S
authors: Vachhrajani
authors: Sandrine
authors: S
authors: de Ribaupierre
authors: Hiroshi
authors: H
authors: Otsubo
authors: Ayako
authors: A
authors: Ochi
authors: Shelly K
authors: SK
authors: Weiss
authors: Elizabeth J
authors: EJ
authors: Donner
authors: Elysa
authors: E
authors: Widjaja
authors: Elizabeth
authors: E
authors: Kerr
authors: Mary Lou
authors: ML
authors: Smith
authors: James
authors: J
authors: Drake
authors: Carter
authors: C
authors: Snead
authors: James T
authors: JT
authors: Rutka
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D019635:Neurosurgical Procedures / Q000379:methods*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18