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Journal of the Korean Child Neurology Society 2005;13(2):165-171.
Published online November 30, 2005.
Results of Surgical Treatments on Intractable Epilepsy with Infantile Spasm.
Young Mock Lee, Byung Ho Noh, Yun Jung Hur, So Hee Eun, Hoon Chul Kang, Joon Soo Lee, Heung Dong Kim
1Department of Pediatrics, Institute for Handicapped Children, Yonsei University College of Medicine, Seoul, Korea. hdkimmd@yumc.yonsei.ac.kr
2Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
3Department of Pediatrics and Epilepsy Center, Sang-gye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Infantile spam is a kind of epileptic syndrome causing delayed psychomotor development in children and one of the most common type of epileptic encephalopathy. Some cases of infantile spasm are known to be caused by focal abnormalities of cerebral cortex thus curable by operating them. Here we analyzed the results of surgical treatments on intractable epilepsy with infantile spasm. METHODS: We performed retrospective study on 22 patients with infantile spasm who received epileptic surgery since 1999. Surgical outcome, pathologic findings, localization of lesions, and types of surgery were reviewed. RESULTS: Sex ratio of our 22 cases was 1:1.4(M:F) and the age at surgery was quite variable. The mean duration from diagnosing epilepsy till operation was 6-10 years in 8(36%) cases, 1-2 years in 7(32%). In preoperative EEG, abnormalities implying possible focal lesion were seen in all 22 patients. 7(32%) out of 22 cases showed focal lesions in MRI while 12(92%) out of 13 cases in ictal SPECT, 8(62%) out of 13 cases in interictal SPECT, and 11(61%) out of 18 cases of PET examination showed abnormal findings. Concerning the types of surgery, single lobectomy was most commonly performed, in 13 (59%) cases in which 11 among them received frontal lobectomy. Also, multilobar resection was performed in 6(27%) cases and hemispherotomy in 2(9%) as well. 19(86%) patients were classified as Engel class I after operations. In pathological examination, cortical dysplasia was most commonly observed, in 11(50%) cases, microdysgenesis in 3(14%), gliosis in 2(9%), and tuberous sclerosis in 2(9%). CONCLUSION: In cases of children with infantile spam not controlled by medical treatment, epileptic surgery should be strongly considered when cortical pathology can be identified from various studies.
Key Words: Infantile spasm, Epilepsy, Surgery, Cortical dysplasia


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