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Hippocampal sclerosis (HS) is a common surgical substrate in adult epilepsy surgery cohorts but variably reported in various pediatric cohorts. We aimed to study the epilepsy phenotype, radiological and pathological variability, seizure and neurocognitive outcomes in children with drug-resistant epilepsy and hippocampal sclerosis (HS) with or without additional subtle signal changes in anterior temporal lobe who underwent surgery. This retrospective study enrolled children with drug-resistant focal epilepsy and hippocampal sclerosis with or without additional subtle T2-Fluid Attenuated Inversion Recovery (FLAR)/Proton Density (PD) signal changes in anterior temporal lobe who underwent anterior temporal lobectomy with amygdalohippocampectomy. Their clinical, EEG, neuropsychological, radiological and pathological data were reviewed and summarized. Thirty-six eligible patients were identified. The mean age at seizure onset was 3.7 years; 25% had daily seizures at time of surgery. Isolated HS was noted in 22 (61.1%) cases and additional subtle signal changes in ipsilateral temporal lobe in 14 (38.9%) cases. Compared to the normative population, the group mean performance in intellectual functioning and most auditory and visual memory tasks were significantly lower than the normative sample. The mean age at surgery was 12.3 years; 22 patients (61.1%) had left hemispheric surgeries. ILAE class 1 outcomes was seen in 28 (77.8%) patients after a mean follow up duration of 2.3 years. Hippocampal sclerosis was noted pathologically in 32 (88.9%) cases; type 2 (54.5%) was predominant subtype where further classification was possible. Additional pathological abnormalities were seen in 11 cases (30.6%); these had had similar rates of seizure freedom as compared to children with isolated hippocampal sclerosis/gliosis (63.6% vs 84%, p=0.21). Significant reliable changes were observed across auditory and visual memory tasks at an individual level post surgery. Favourable seizure outcomes were seen in most children with isolated radiological hippocampal sclerosis. Patients with additional pathological abnormalities had similar rates of seizure freedom as compared to children with isolated hippocampal sclerosis/gliosis. • Subtle anterior temporal signal changes were noted in 38.9% children with hippocampal sclerosis (HS). • 77.8% children became seizure free after anterior temporal lobectomy with amygdalohippocampectomy. • Overall, 30.6% cases had additional pathological abnormalities. • Seizure freedom rates of children with additional pathological abnormalities similar to those with isolated HS. [ABSTRACT FROM AUTHOR]

Highlights: [•] Annual percent of potentially eligible population who actually have surgery is only 1%. [•] Time from first seizure to EMU referral was approximately 4.6 years. [•] Time from EMU referral to surgery 1.6 years with iEEG and 1.1 years without iEEG. [•] Surgical patients: 95% reduced seizure frequency and 74% seizure free one year post-surgery. [ABSTRACT FROM AUTHOR]

Summary: Introduction: To identify the perceived practice among Canadian epileptologists regarding discontinuation of antiepileptic drugs (AEDs) following successful resective surgery for temporal and extratemporal surgery. Methods: We performed a survey of pediatric and adult epileptologists in Canada, using a 77-item questionnaire to explore attitudes, timing, rate of withdrawal, and factors contributing to the decision to withdraw AEDs after successful epilepsy surgery. Surveys were mailed with a postage-paid return envelope. Two subsequent surveys were mailed to non-respondents at 15 days intervals. All procedures received institutional review board approval. Results: Surveys were sent to 82 epileptologists in all the Canadian provinces. Sixty-six physicians answered the survey (80.5%), representing all epilepsy centers across Canada. The minimum seizure free period required after epilepsy surgery before withdrawing AEDs, varied substantially among responders: <6 months in 10%, 6–11 months in 21%, >1 year in 50%, >2 years in 12%, >2 years in 3% after. The most important factors influencing the decision to withdraw AEDs a negative EEG before discontinuation (71%), patients’ preferences (78%) and the presence of unilateral mesial temporal sclerosis (70%). The most important factors against reduction were the following: patients’ wishes to resume driving (67%), focal (65%) or generalized (78%) epileptiform activity on EEG after surgery, persistent isolated auras (78%), any seizures after hospital discharge (81%), and presurgical multifocal/bilateral/diffuse findings (78%). Discussion: Canadian epileptologists indicated that AED levels, EEG and MRI are typically done before discontinuing AEDs. Generally, a good candidate for stopping AEDs has focal pathology, is completely seizure free, had an anterior temporal lobe resection, complete resection of seizure focus, and has no epileptiform discharges on postoperative EEG. The data pertaining to self-reported practice styles, and actual practice may differ. [Copyright &y& Elsevier]

Summary: Introduction: Occipital lobe epilepsy (OLE) poses a diagnostic challenge to clinicians. Here, we present our experience in the surgical management of OLE in children using magnetoencephalography (MEG) in the pre-operative evaluation. Methods: Retrospective chart review was performed from 2000 to 2010 to identify patients with OLE. Patients were analyzed in two categories: isolated OLE (11 patients) and extended OLE (parietooccipital, temporooccipital, and temporoparietooccipital; 30 patients). Survival analysis and multivariate Cox proportional hazards regression were used to identify independent predictors of seizure outcome. Results: Forty-one patients with a mean follow-up of 3.1 years were identified with an overall 68% rate of satisfactory seizure outcome. Patients with extended OLE had younger ages at seizure onset and different seizure semiologies compared with those with isolated OLE. None of the latter underwent insertion of subdural grid electrodes for localization of the epileptogenic zone compared with 77% of the former (p <0.001). On multivariate analysis, the strongest independent predictor of unsatisfactory outcome was MEG dipoles in the occipital lobe contralateral to resection. Conclusion: Here, we find similar seizure outcomes for isolated and extended OLE foci despite the use of less invasive strategies for the former. Furthermore, we describe the role of MEG in evaluation, surgical planning and prognostication of children with OLE. [Copyright &y& Elsevier]