Epilepsy Surgery in Children with Minimal Presurgical Video-EEG Monitoring

Background: Epilepsy surgery can potentially cure drug-resistant epilepsy, but careful presurgical evaluation is vital to select patients who will profit from such an intervention. Many epilepsy surgery programs offer extensive presurgical evaluation including several days of video EEG monitoring. Non-lesional epilepsy cases are rare upon epilepsy-surgery patients. We therefore set up a lesion-orientated pediatric epilepsy surgery program for patients with clearly localized lesions that involved only minimal presurgical diagnostics, particularly with max. 48 hours of non-invasive EEG monitoring that did not necessarily include ictal EEGs.

Methods: We evaluated retrospectively the outcome of patients who were operated within our epilepsy surgery program with respect to seizure freedom and cognition.

Results: Of 135 patients evaluated for epilepsy surgery, 36 children and adolescents underwent a resective procedure at a mean age of 8.37 ± 4.7 years (range: 0.35–18.78). The most frequent surgery was a hemispherotomy. Overall seizure freedom was 73.9% after 12 months and 77.8% at a current median observation period of 16.5 months. Seizure frequency was reduced <50% in all other patients. After surgery, IQ values increased slightly from mean 59.87 ± 26.29 to 63.46 ± 28.71. In patients who had lost IQ points after surgery, no cognitive regression occurred. These patients developed more slowly than children with an average development speed. Individually they achieved better results than preoperatively or stagnated.

Conclusion: Despite the limits due to the patient selection, our findings highlight the high success rate using a lesion-orientated epilepsy surgery approach with reduced presurgical video EEG monitoring in the pediatric epilepsy population.

Publication History

Article published online:
28 October 2021