title: Posterior cortex epilepsy surgery in childhood and adolescence: Predictors of long-term seizure outcome.
abstract: We aimed to investigate the long-term seizure outcome of children and adolescents who were undergoing epilepsy surgery in the parietooccipital cortex and determine their predictive factors.
  
  
  
  We retrospectively analyzed the data of 50 consecutive patients aged 11.1 (mean) ± 5.1 (standard deviation) years at surgery. All patients but one had a magnetic resonance imaging (MRI)-visible lesion. Resections were parietal in 40%, occipital in 32%, and parietooccipital in 28% cases; 24% patients additionally underwent a resection of the posterior border of the temporal lobe. Etiology included focal cortical dysplasia in 44%, benign tumors (dysembryoplastic neuroepithelial tumor, ganglioglioma, angiocentric glioma, and pilocystic astrocytoma) in 32%, peri- or postnatal ischemic lesions in 16%, and tuberous sclerosis in 8% cases.
  
  
  
  At last follow-up (mean 8 years, range 1.5-18 years), 60% patients remained seizure-free (Engel class I): 30% had discontinued and 20% had reduced antiepileptic drugs. Most seizure recurrences (71%) occurred within the first 6 months, and only three patients presented with seizures ≥2 years after surgery. Independent predictors of seizure recurrence included left-sided as well as parietal epileptogenic zones and resections. Longer epilepsy duration to surgery was identified as the only modifiable independent predictor of seizure recurrence.
  
  
  
  Our study demonstrates that posterior cortex epilepsy surgery is highly effective in terms of lasting seizure control and antiepileptic drug cessation in selected pediatric candidates. Most importantly, our data supports the early consideration of surgical intervention in children and adolescents with refractory posterior cortex epilepsy.
authors.affiliation: Epilepsy Center, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Georgia
authors.identifier: 0000-0002-7931-2327
authors.initials: G
authors.lastname: Ramantani
authors.affiliation: Epilepsy Center, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Stathi
authors.affiliation: Epilepsy Center, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.affiliation: Epilepsy Center Kork, Kehl-Kork, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Strobl
authors.affiliation: Department of Neuropediatrics and Metabolic Disease, University Children's Hospital, Heidelberg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Schubert-Bast
authors.affiliation: Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Wiegand
authors.affiliation: Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Korinthenberg
authors.affiliation: Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: van Velthoven
authors.affiliation: Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.affiliation: Epilepsy Center, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
authors.affiliation: Epilepsy Center Kork, Kehl-Kork, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bast
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: Focal cortical dysplasia; Glioneuronal tumors; Occipital; Parietal; Refractory epilepsy