Surgical Outcomes and Prognostic Factors after Epilepsy Surgery in Children with Extratemporal Lobe Epilepsy / 대한소아신경학회지

PURPOSE: In this study, we reviewed surgical outcomes in children with extratemporal lobe epilepsy in our institution and suggested prognostic factors from these results. METHODS: We retrospectively analyzed the records of 59 patients(males n=35, females n=24; mean age of 10 years, mean age of seizure onset of 3 years, mean age of epilepsy surgery of 8 years) who received extratemporal lobe surgery between October 2003 to May 2008. Every patients were performed preoperative evaluation to determine the anatomical location of the ictal onset zone employing video electroencephalography(EEG) monitoring, intraoperative electrocorticography, intracranial EEG monitoring and neuroimagings such as Magnetic Resonance Imaging (MRI), positron emission tomography, interictal/ictal single photon emission computed tomography. Developmental test was taken at pre- and post-operation. RESULTS: Postoperative outcome as defined by Engel's classification were as follows; class I in 42(71.2%), II in 6(10.2%), III in 4(6.8%), and IV in 7(11.9%) patients. We considered six favorable prognostic factors from our data; age at operation, matching accuracy of video-EEG monitoring results, presence of a structural lesion on MRI, using specialized neuromodalities, involvement of lobe at surgery, and nature of the epileptogenic lesion. We also focused on unfavorable prognostic factors; no structural lesion on MRI, low grade of surgical pathology, postoperative epileptiform discharges on EEG. CONCLUSION: Early surgical intervention in pediatric patients with medically refractory seizure who possess focal epileptogenic foci of extratemporal lobe origin has been an effective and safe treatment.

Surgical Outcomes after Epilepsy Surgery in Children with Extratemporal Lobe Epilepsy / 대한소아신경학회지

PURPOSE: We retrospectively reviewed the presurgical data and postoperative outcome in children underwent extratemporal respective surgeries. METHODS: The twenty six patients(males 15, females 11, mean age 11.5 years, mean age of operation 9.3 years, mean age after operation 2.3 years) who received extratemporal lobe surgery in our institution between October 2003 to May 2008 were reviewed. Preoperative evaluation(video-EEG monitoring and neuroimagings) to determine the anatomical location of the ictal onset zone were used to delineate possible localized malformed cerebral cortex. We also performed intraoperative electrocorticography(EcoG), intracranial EEG monitoring. RESULTS: Postoperative outcome as defined by Engel classification were as follows; class I in 19(73%), II in 1(3.8%), III in 1(3.8%), and IV in 5(19.2%) patients. Most common pathologies were cortical dysplasia and microdysgenesis. Twenty patients received frontal, 2 patients received parietal, and 4 patients received occipital lobectomy. After surgery, marked improvement in developmental outcome was noted. Postsurgical complications were noted in 9 cases, without lasting sequelae. CONCLUSION: We achieved a seizure-free rate of 73% in pharmacoresistant epileptic pediatric patients after extratemporal lobectomy. From this experience, we recommend early surgical intervention in pediatric patients with medically refractory seizure who possess focal epileptogenic foci of extratemporal lobe origin, as we can expect higher success rate and fewer postsurgical complications compared to those reported in adults. The Multimodal investigation and wide resections of the cortex based on the EcoG findings might be necessary to better localize the site of extratemporal epilepsy and to reduce postoperative complications.

Multiple Intestinal Perforations in a Child with Behcet's Disease / 대한소아소화기영양학회지

Behcet's disease (BD) is a multisystem inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis and erythema nodosum. BD is very rare in children, especially those less than 10 years of age, who account for only an estimated 5% of all cases. Gastrointestinal ulcers, in patients with Behcet's disease with intestinal involvement are rare and have been reported in only 1-2% of all cases. The intestinal ulcers of Behcet's disease are usually multiple and scattered and tend to cause perforations associated with significant morbidity. Patients with BD and abdominal symptoms must be evaluated thoroughly for potential perforation of the gastrointestinal tract. Here we report the case of a 4 year 9 month old child with multiple perforations of the gastrointestinal tract associated with BD.