title: Unilobar surgery for symptomatic epileptic spasms.
abstract: To assess factors associated with favorable seizure outcome after surgery for symptomatic epileptic spasms and improve knowledge on pathophysiology of this seizure type.
  
  
  
  Inclusion criteria were: (1) age between 6 months and 15 years at surgery; (2) active epileptic spasms; (3) follow-up after surgery >1 year.
  
  
  
  We retrospectively studied 80 children (aged 1.3 ± 2 years at seizure onset; 5.8 ± 4 years at surgery, 11.7 ± 5.7 years at last follow up). Magnetic resonance imaging (MRI) revealed structural abnormalities in 77/80 patients (96.3%; unilateral in 69: 89.6%). We performed invasive recordings in 24 patients (30%). In 21 patients in whom MRI or histopathology detected a lesion, electrodes exploring it constantly captured initial ictal activity at spasm onset. Fifty-eight patients (72.5%) underwent unilobar and 22 (27.5%) multilobar or hemispheric procedures. At last follow-up, 49 patients (61.3%) were in Engel class I. Multivariate logistic models showed completeness of resection of the seizure onset zone (OR = 0.016, 95%CI: 0.002, 0.122) and of the MRI visible lesion (OR = 0.179, 95% CI: 0.032, 0.999) to be significantly associated with Engel class IA outcome. Unfavorable outcome was associated with an older age at surgery, when it reflected a longer duration of epilepsy (OR = 1.383, 95% CI: 0.994,1.926).
  
  
  
  Data emerging from invasive recordings and the good seizure outcome following removal of discrete epileptogenic lesions support a focal cortical origin of spasms. In patients with discrete epileptogenic lesions, the pragmatic approach to surgery should follow the same principles applied to focal epilepsy favoring, whenever possible, unilobar, one-stage resections.
authors.affiliation: Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy.
authors.forename: Carmen
authors.identifier: 0000-0001-5445-5842
authors.initials: C
authors.lastname: Barba
authors.affiliation: "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mai
authors.affiliation: Department of Statistics, Computer Science, Applications "G. Parenti" University of Florence Florence Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Grisotto
authors.affiliation: "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gozzo
authors.affiliation: Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy; IRCCS Stella Maris Pisa Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Pellacani
authors.affiliation: "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.affiliation: "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Francione
authors.affiliation: Neurosurgery Department Children's Hospital Anna Meyer-University of Florence Florence Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Giordano
authors.affiliation: "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy.
authors.forename: Francesco
authors.identifier: 0000-0002-5141-9202
authors.initials: F
authors.lastname: Cardinale
authors.affiliation: Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy; IRCCS Stella Maris Pisa Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Guerrini