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International Journal of Pediatrics
Volume 2012 (2012), Article ID 527891, 7 pages
http://dx.doi.org/10.1155/2012/527891
Clinical Study

Outcomes of Disconnective Surgery in Intractable Pediatric Hemispheric and Subhemispheric Epilepsy

1Division of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India
2Division of Pediatric Neurology, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India
3Division of Neurophysiology, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India
4Department of Child and Adolescent Psychiatry, Christian Medical College, Vellore 632004, India
5Division of Neurosurgery, Department of Clinical Neurosciences, CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland

Received 31 July 2011; Revised 2 November 2011; Accepted 2 November 2011

Academic Editor: Alan Richard Spitzer

Copyright © 2012 Santhosh George Thomas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy. Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel’s classification and cognitive skills by appropriate measures of intelligence that were repeated annually. Results: There were 34 patients in all. Epilepsy was due to Rasmussen’s encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome. Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.