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Updated: May 27, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Surgical outcomes for intractable epilepsy in children with epileptic spasms
Brian D Moseley1, Katherine Nickels, Elaine C Wirrell
1Department of Neurology, Mayo Clinic, Rochester, MN, USA. moseley.brian@mayo.edu
Insights
Epilepsy surgery can be effective for children with medically intractable epileptic spasms. Over half of patients achieved seizure freedom, with positive developmental outcomes linked to surgical success.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Epileptic spasms are a challenging seizure type, often resistant to medication.
- Identifying effective treatments for medically intractable cases is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the efficacy and outcomes of epilepsy surgery in pediatric patients with medically intractable epileptic spasms.
- To identify predictors of successful surgical intervention in this population.
Main Methods:
- Retrospective analysis of 11 children with epileptic spasms undergoing various surgical procedures (lesionectomy, lobectomy, etc.).
- Evaluation of seizure status, concurrent seizure types, and postoperative EEG findings.
- Assessment of developmental outcomes reported by parents/caregivers.
Main Results:
- 55% of children (6 out of 11) became seizure-free after surgery.
- Lack of focal slowing and fewer than 2 interictal epileptiform abnormalities on postoperative EEG predicted favorable outcomes.
- Improved developmental outcomes were significantly associated with seizure freedom.
Conclusions:
- Epilepsy surgery offers a viable treatment option for children with intractable epileptic spasms.
- Postoperative EEG findings and developmental progress are important indicators of surgical success.
Abstract:
Epileptic spasms, or seizures marked by flexor, extensor, or flexor-extensor spasms, are not always responsive to medical management. The purpose of our study was to evaluate the outcome of epilepsy surgery in children with medically intractable epileptic spasms. We identified 11 children with epileptic spasms who underwent lesionectomy (36%), lobectomy (27%), multi-lobectomy (9%), hemispherectomy (18%), or corpus callosotomy (9%). At the time of surgery, 6 children had developed other concurrent seizure type(s), including simple partial (9%), complex partial (27%), partial undifferentiated (9%), primary generalized tonic clonic (9%), tonic (9%), atonic (27%), and myoclonic (9%) seizures. Six children (55%) were seizure free at last follow-up from initial surgery. Predictors of favorable outcome included lack of focal slowing and the presence of less than 2 interictal epileptiform abnormalities on postoperative electroencephalogram (P = .035 and .035, respectively). Favorable outcome was significantly associated with parent/caregiver report of improved postoperative developmental outcomes (P = .026).
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