Epilepsy Surgery and Prognostic Factors In Children With Epilepsy

Objective: Our aim is to evaluate the predictors of seizure freedom in children with epilepsy who underwent resective or functional surgery (VNS). Methods: Data regarding 191 children (0-18 years) who underwent epilepsy surgery between 2000-2020 were retrospectively analyzed. Demographics, Video EEG monitoring, neuroimaging, and postoperative seizure freedom were evaluated based on prediction scale (HOPS). Results: Of the total 89 (46.6%) patients who had been examined for resective surgery, 82.1 % were diagnosed with temporal lobe epilepsy (TLE) and 17.9% had extra TLE. 81(91.1%) were seizure-free, of which 86.4% had TLE, and 13.6% had extra TLE. HOPS score was applied to predict seizure freedom in which the score of 1 or 2 was associated with excellent seizure control. Three patients were followed <3 months, 28 patients between 3 months-3.5 years, 3.5 years< 58 patients. Eight patients had generalized seizure semiology. All had structural and non stroke etiology. One patient had contralateral hipometabolism in PET. Two patients had previous surgery. The HOPS score was found 1 in 49 (55%) patients, 2 in 26(29.5%) patients, 3 in 9 (10%) patients, and 4 in 4 (4.5%) patients. VNS was applied in 102 patients. There was more than 50% seizure control in 55 of the patients. Nine patients had seizure freedom with VNS. Significance: Epilepsy surgery is one of the effective treatment options in intractable epilepsy. Using HOPS score, younger seizure onset, generalized seizure semiology, and multilobar epileptogenic zone are found to be the most important predictive factors which can be used in pediatric cases.