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The study aimed to summarize the indications and clinical features of pediatric drug-resistant epilepsy associated with early brain injury, surgical outcomes, and prognostic factors. We retrospectively analyzed children diagnosed with drug-resistant epilepsy due to early brain injury, who had undergone surgery at the Pediatric Epilepsy Center of Peking University First Hospital from May 2014 to May 2021. Clinical data of vasculogenic and non-vasculogenic injuries from early brain damage were compared and analyzed. The surgical outcomes were assessed using the Engel grading system. The median ages at acquiring injury, seizure onset, and surgery among 65 children were 19.0 (0–120) days, 8.6 (0–136.5) months, and 62.9 (13.5–234) months, respectively. Of the 14 children with non-vasculogenic injuries, 12 had posterior ulegyria. Unilateral or bilateral synchronous interictal epileptiform discharges were located mainly in the posterior quadrant in 10 children (71 %), and unilateral posterior quadrant or non-lateralized ictal region in eight children (57 %). The surgical approach was mainly temporo-parieto-occipital or parieto-occipital disconnection in nine children. Of 49 children with vasculogenic injuries, magnetic resonance imaging revealed hemispheric abnormalities in 38. Unilaterally hemispheric or bilateral interictal epileptiform discharges were observed in 36 children (73 %), whereas 42 (86 %) had unilateral hemispheric or non-lateralized ictal onset. The surgical procedure involved hemispherotomy in 38 children (78 %) and lobectomy or disconnection, multilobectomy or disconnection and hemispherotomy in 5, 20, and 40 children, respectively. Fifty-five patients (84.6 %) achieved remission from seizure during follow-up at 5.4 years. Age at surgery (odds ratio = 1.022, 95 % confidence interval = 1.003–1.042, P = 0.023) and etiology (odds ratio = 17.25, 95 % confidence interval = 2.778–107.108, P = 0.002) affected the seizure outcomes. Children with drug-resistant epilepsy due to early brain injury can successfully be treated with surgery after rigorous preoperative screening. Good surgical outcomes are associated with an early age at surgery and an etiology of vasculogenic injury. [ABSTRACT FROM AUTHOR]

Abstract Objective The present study investigated the electroclinical features and epileptogenic networks of parietal operculum seizures (POS) by using stereoelectroencephalography (SEEG) intracerebral recordings. Methods Comprehensive presurgical evaluation data of seven patients with drug-resistant epilepsy with POS were analyzed retrospectively. Stereoelectroencephalography-recorded seizures were processed visually and quantitatively by using epileptogenicity mapping (EM), which has been proposed to ergonomically quantify the epileptogenicity of brain structures with a neuroimaging approach. Results Six patients reported initial somatosensory or viscerosensitive symptoms. Ictal clinical signs comprised frequently nocturnal hypermotor seizures and contralateral focal motor seizures, including tonic, tonic–clonic, or dystonic seizures of the face and limbs. Interictal and ictal scalp EEG provided information regarding lateralization in the majority of patients, but the discharges were widely distributed over perisylvian or "rolandic-like" regions and the vertex. Furthermore, two subgroups of epileptogenic network organization were identified within POS by SEEG, visually and quantitatively, using an EM approach: group 1 (mesial frontal/cingulate networks) was observed in three patients who mainly exhibited hypermotor seizures; group 2 (perisylvian networks) was observed in four patients who mainly exhibited contralateral focal motor seizures. Conclusion This study indicated that POS could be characterized by initial specific somatosensory sensations, followed by either frequently nocturnal hypermotor seizures or contralateral focal motor seizures. The distinctive seizure semiology depended on the organization of two primary epileptogenic networks. This article is part of the Special Issue "Individualized Epilepsy Management: Medicines, Surgery and Beyond. Highlights • Parietal operculum seizures were characterized by initial specific somatosensory sensations, followed by either frequently nocturnal hypermotor seizures or contralateral focal motor seizures. • Two subgroups of epileptogenic networks could be identified within parietal operculum seizures: mesial frontal/cingulate networks and perisylvian networks. [ABSTRACT FROM AUTHOR]