Surgical Outcomes and Prognostic Factors of Children with Drug-Resistant Epilepsy

Objective To analyze the surgical outcomes of children of drug-resistant epilepsy and to investigate prognostic factors for surgery.Methods Seventy-six drug-resistant epilepsy patients(aged 14 or below) underwent operation from March 2007 to September 2009 and followed-up for at least 1 year were enrolled.Individualized microsurgical resections aimed at removal of the epileptogenic zone was performed according to the results of presurgical evaluations including video-EEG,MRI,PET-CT,invasive electroencephalogram and neurophysiology.Patients were categorized as Engel class Ⅰ and Engel class Ⅱ～Ⅳ.Univariate analysis was applied for the possible prognostic factors.Then further multivariate logistic regression analysis was employed for statistically significant factors from the univariate analysis.Results 38 patients(50.0%) were Engel class I,27(35.5%) were Engel class Ⅱ～Ⅲ,and 11(14.5%) were Engel class Ⅳ.No long-term paralysis or death cases were noted.Multivariate logistic regression analysis showed that older than 4 years of age at epilepsy onset[P=0.047,OR=3.473,95% CI(1.017,11.855)],complex partial seizures[P=0.021,OR=4.678,95% CI(1.264,17.314)] and temporal unilobar resection[P=0.026,OR=3.766,95% CI(1.170,12.123)] were the strongest prognostic indicators of Engel class Ⅰ outcome.Epilepsy duration,seizure frequency,and intelligence quotient were not independent prognostic factors for surgical outcomes.Age at surgery,MRI-positive,sex,PET-CT performance,and IEEG performance did not affect surgical outcomes.Conclusion Surgery for children of drug-resistant epilepsy is both effective and safe.In view of the surgical prognostic factors,a comprehensive presurgical evaluation and criteria for inclusion are necessary for good prognosis.