title: Surgical treatment for refractory epileptic spasms: The Detroit series.
abstract: OBJECTIVE
  We reviewed our experience of surgery for epileptic spasms (ES) with or without history of infantile spasms.
  
  
  METHODS
  Data were reviewed from 65 (33 male) patients with ES who underwent surgery between 1993 and 2014; palliative cases were excluded.
  
  
  RESULTS
  Mean age at surgery was 5.1 (range 0.2-19) years, with mean postsurgical follow-up of 45.3 (6-120) months. Mean number of anticonvulsants used preoperatively was 4.2 (2-8), which decreased to 1.2 (0-4) postoperatively (p < 0.0001). Total hemispherectomy was the most commonly performed surgery (n = 20), followed by subtotal hemispherectomy (n = 17), multilobar resection (n = 13), lobectomy (n = 7), tuberectomy (n = 6), and lobectomy + tuberectomy (n = 2), with International League Against Epilepsy (ILAE) class I outcome in 20, 10, 7, 6, 3, and 0 patients, respectively (total 46/65 (71%); 22 off medication). Shorter duration of epilepsy (p = 0.022) and presence of magnetic resonance imaging (MRI) lesion (p = 0.026) were independently associated with class I outcome. Of 34 patients operated <3 years after seizure onset, 30 (88%) achieved class I outcome. Thirty-seven (79%) of 47 patients with lesional MRI had class-I outcome, whereas 9 (50%) of 18 with normal MRI had class I outcome. Positron emission tomography (PET) scan was abnormal in almost all patients [61 (97%) of 63 with lateralizing/localizing findings in 56 (92%) of 61 patients, thus helping in surgical decision making and guiding subdural grid placements, particularly in patients with nonlesional MRI. Fifteen patients had postoperative complications, mostly minor.
  
  
  CONCLUSIONS
  Curative epilepsy surgery in ES patients, with or without history of infantile spasms, is best accomplished at an early age and in those patients with lesional abnormalities on MRI with electroencephalography (EEG) concordance. Good outcomes can be achieved even when there is no MRI lesion but positive PET localization.
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.|Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Harry T
authors.initials: HT
authors.lastname: Chugani
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.|Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ilyas
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.|Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.|Department of Radiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.|Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Csaba
authors.initials: C
authors.lastname: Juhász
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: William J
authors.initials: WJ
authors.lastname: Kupsky
authors.affiliation: Department of Neurosurgery, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sood
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.|Department of Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Eishi
authors.identifier: http://orcid.org/0000-0001-8391-4067
authors.initials: E
authors.lastname: Asano
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000473:pathology / Q000601:surgery*; D000069280:Electrocorticography; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000209:etiology; D013036:Spasms, Infantile / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Epilepsy surgery; Epileptic spasms; FDG-PET; Seizure; West syndrome