Original Article Seizure outcomes in children with epilepsy after resective brain surgery Lakshmi Nagarajan * , Michael Lee, Linda Palumbo, Sharon Lee, Snehal Shah, Peter Walsh, Patricia Cannell, Soumya Ghosh Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Perth, Australia article info Article history: Received 6 December 2014 Received in revised form 25 April 2015 Accepted 27 May 2015 Keywords: Epilepsy surgery Children Brain tumours ECoG AED withdrawal Refractory epilepsy abstract Purpose: To assess the role of resective brain surgery in childhood epilepsy. Methodology: We retrospectively analysed the seizure outcomes in 55 children with epilepsy who had resective brain surgery between 1997 and 2012, at our centre. The children were 1.5e18 years at the time of surgery; their seizure onset was between 0.2 andto 15 years of age. 48 had refractory epilepsy. One child died of tumour progression. Follow-up duration in the survivors ranged from 2 to À16 years (mean: 9).Presurgical evaluation included clinical profiles, non-invasive V-EEG monitoring, neuroimaging with MRIs in all; SPECT and PET in selected patients. 54 had intraoperative ECoG. Results: An Engel Class 1 outcome was seen in 78% of the cohort, with 67% being off all AEDs at the most recent follow-up. Children with tumours constituted the majority (56%), with 87% of this group showing a Class 1 outcome and 84% being off AEDs. Children with cortical dysplasia had a Class 1 outcome in 56%. Conclusion: Resective brain surgery is an efficacious option in some children with epilepsy. We found ECoG useful to tailor the cortical resection and in our opinion ECoG contributed to the good seizure outcomes. © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. 1. Introduction Epilepsy in Children spans a wide spectrum of disorders-from the benign focal epilepsies of childhood to catastrophic syn- dromes like West and Lennox Gastaut, as well as unique syndromes such as Landau Kleffner syndrome. Antiepileptic drugs remain the mainstay of treatment for childhood epi- lepsy. However about 20e30% of children have refractory ep- ilepsy, in some of them resective brain surgery would be a suitable option. Advances in neurophysiology, neuroimaging, neuroanaesthetic care and neurosurgery have made epi- lepsy surgery safer and more readily available to young chil- dren. In certain situations such as tumour related epilepsy, * Corresponding author. Children's Neuroscience Service, Department of Neurology, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA 6008, Australia. Tel.: þ61 8 93408364; fax: þ61 8 93407063. E-mail addresses: lakshmi.nagarajan@health.wa.gov.au (L. Nagarajan), leema@cygnus.uwa.edu.au (M. Lee), linda.palumbo@health. wa.gov.au (L. Palumbo), sharon.lee@health.wa.gov.au (S. Lee), snehal.shah@health.wa.gov.au (S. Shah), peter.walsh@health.wa.gov.au (P. Walsh), patricia.cannell@health.wa.gov.au (P. Cannell), soumya.ghosh@health.wa.gov.au (S. Ghosh). Official Journal of the European Paediatric Neurology Society european journal of paediatric neurology 19 (2015) 577 e583 http://dx.doi.org/10.1016/j.ejpn.2015.05.006 1090-3798/© 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.