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Updated: Jun 4, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Outcome of epilepsy surgery in children after evaluation with non-invasive protocol
Sita Jayalakshmi1, Manas Panigrahi, Dilip Kumar Kulkarni
1Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. sita_js@hotmail.com
Insights
Epilepsy surgery in children can achieve favorable outcomes, with predictors of success including MRI lesions and normal IQ. Non-invasive evaluation is key for medically refractory partial epilepsy.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Medically refractory partial epilepsy in children poses significant challenges.
- Non-invasive diagnostic protocols are crucial for treatment planning.
Purpose of the Study:
- To evaluate the outcomes of epilepsy surgery in children with medically refractory partial epilepsy.
- To identify predictors of successful surgical outcomes.
Main Methods:
- Retrospective analysis of 87 children with at least 1-year post-surgery follow-up.
- Engel's outcome classification used for assessment.
- Stepwise and logistic regression analyses for predictor identification.
Main Results:
- 64.1% achieved seizure freedom, and 75.6% had favorable outcomes (Engel's classification).
- Predictors of favorable outcome: MRI lesion, normal IQ, partial seizures without generalization.
- Predictors of poor outcome: bilateral spikes on EEG, acute postoperative seizures.
Conclusions:
- Epilepsy surgery offers favorable outcomes in children with specific conditions like temporal lobe epilepsy with hippocampal sclerosis.
- Non-invasive evaluation protocols are effective, even in resource-limited settings.
- Identifying predictive factors aids in optimizing surgical candidacy and outcomes.
Objective:
To assess outcome of epilepsy surgery in children with medically refractory partial epilepsy evaluated with non-invasive protocol and to determine the predictors of outcome.
Patients And Methods:
Retrospective analysis of presurgical, surgical, and postsurgical data was performed in 87 children who had at least 1 year post surgery follow-up. Outcome was assessed according to Engel's outcome classification. Stepwise regression followed by logistic regression analysis was employed in data analysis.
Results:
Mean follow-up was 32 (12-58) months and 44 (50.6%) were males. The age of onset of epilepsy was below the age of 2 years in 24 (30.8%). Resective surgery was done in 78 children. The commonest surgery performed was a temporal resection (88.9%) in adolescents and an extra-temporal resection ( 60.6%) in children. The commonest pathology was hippocampal sclerosis (HS) in adolescents and developmental, tumoral lesions, and gliosis in children. At last follow-up, 50 (64.1%) were seizure free and Engel's favourable outcome was noted in 59 (75.6%). After stepwise regression analysis, variables found to be significant (P < 0.05) and predicting a favourable outcome were lesion on MRI, normal IQ, and partial seizures without secondary generalization. Bilateral spikes on interictal EEG and acute postoperative seizures were predictors of poor outcome. A regression model was developed; the sensitivity, specificity, accuracy, and area under ROC curve were 82%, 91%, 88.5%, and 0.97%, respectively.
Conclusion:
Favourable outcome after epilepsy surgery can be obtained in children with temporal lobe epilepsy with HS and lesion-related epilepsies in developing countries with limited resources, after evaluation with a non-invasive protocol.
