Epilepsia, 49(1):146–155, 2008 doi: 10.1111/j.1528-1167.2007.01421.x SPECIAL REPORT Defining the spectrum of international practice in pediatric epilepsy surgery patients * †Simon Harvey, ‡ J. Helen Cross, §Shlomo Shinnar, ¶Bary W. Mathern, and the ILAE Pediatric Epilepsy Surgery Survey Taskforce * * Department of Pediatrics, University of Melbourne, Melbourne, Australia; †Department of Neurology, Royal Children’s Hospital, Parkville, Victoria, Australia; ‡UCL Institute of Child Health & Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; §Department of Neurology, Pediatrics and Epidemiology and Population Health and the Comprehensive Epilepsy Management Center, Albert Einstein College of Medicine, Bronx, New York; and ¶Department of Neurosurgery, The Mental Retardation Research Center, and The Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A. On behalf of the ILAE Subcommission for Pediatric Epilepsy Surgery, and the Commissions on Therapeutic Strategies and Pediatrics SUMMARY Purpose: The Pediatric Epilepsy Surgery Sub- commission of the International League Against Epilepsy conducted a survey to determine the fre- quency of epilepsy procedures and etiologies. Methods: Data were gathered from 20 programs in the United States, Europe, and Australia on 543 patients (<18 years) for calendar year 2004. Results: Age at seizure onset was 1 year or less in 46% of patients. Intracranial electrodes were used in 27% of patients. The most common final opera- tion was lobar and focal resections of the frontal and temporal lobes (41%), followed by cerebral hemispherectomy (16%), vagus nerve stimulator (16%), and multilobar resections (13%). Multiple- subpial transections were uncommon procedures (0.6%). The most frequent etiologies were cortical dysplasia (42%), tumors (19%), and atrophic lesions and strokes (10%). Less common were vascular le- sions (1.5%), Rasmussen encephalitis (3%), Sturge– Weber (3%), and operations for infantile spasms (4%), and Landau–Kleffner/ESES (<2%). Children <4 years generally presented with daily seizures from cortical dysplasia and underwent multilo- bar or hemispherectomy. Previous surgeries be- fore 2004 were reported in 22%, and occurred more commonly in patients with tumors (40%), hypothalamic hamartomas (47%), and vascular le- sions (67%). U.S. centers reported more vagus nerve stimulator procedures, operated more often on children with no or subtle MRI findings, and used intracranial electrodes and functional neuroimag- ing more frequently than programs in Europe and Australia. Conclusions: The results of this international sur- vey show the feasibility of international collabora- tions in determining epilepsy etiologies and proce- dures in children, and suggest differences in clinical practice between regions of the world. These re- sults can guide the design of future studies in pro- ducing guidelines for therapy-resistant pediatric epilepsy surgery patients. KEY WORDS: Seizure syndrome, Etiologies, Re- operation, Epileptic encephalopathy, Intracarotid amobarbital procedure, MRI, FDG-PET, Ictal- SPECT, Tumor. The Commission on Neurosurgery of the International League Against Epilepsy (ILAE) formed the Pediatric Accepted October 8, 2007; Online Early publication November 21, 2007. Address correspondence to J. Helen Cross, Institute of Child Health, The Wolfson Centre, Mecklenburgh Square; London, WC1N 2AP. E- mail: hcross@ich.ucl.ac.uk ∗ Table 1 indicates the complete list of associated authors and affilia- tions. Blackwell Publishing, Inc. C  2008 International League Against Epilepsy Epilepsy Surgery Subcommission in 1998. Its charge was to create minimal standards and guidelines for epilepsy surgery in children. After several meetings over 5 years, the Subcommission concluded that the medical literature con- tained insufficient Class I and II data to formulate surgical guidelines for children. Instead, based on expert consensus of 32 individuals representing 19 centers from 12 coun- tries, the committee proposed criteria for referral and eval- uation of children for epilepsy surgery (Cross et al., 2006). In creating these recommendations, the Subcommission 146