Summary Recent findings on the clinical, electroencephalography (EEG), neuroimaging, and surgical outcomes are reviewed comparing patients with Palmini type I (mild) and type II (severe) cortical dysplasia. Resources include peer‐reviewed studies on surgically treated patients and a subanalysis of the 2004 International League Against Epilepsy (ILAE) Survey of Pediatric Epilepsy Surgery. These sources were supplemented with data from University of California, Los Angeles (UCLA). Cortical dysplasia is the most frequent histopathologic substrate in children, and the second most common etiology in adult epilepsy surgery patients. Cortical dysplasia patients present with seizures at an earlier age than other surgically treated etiologies, and 33–50% have nonlocalized scalp EEG and normal magnetic resonance imaging (MRI) scans. 2‐(18F)Fluoro‐2‐deoxy‐D‐glucose positron emission tomography (FDG‐PET) is positive in 75–90% of cases. After complete resection, 80% of patients are seizure free compared with 20% with incomplete resections. Compared with type I, patients with type II cortical dysplasia present at younger ages, have higher seizure frequencies, and are extratemporal. Type I dysplasia is found more often in adult patients in the temporal lobe and is often MRI negative. These findings identify characteristics of patients with mild and severe cortical dysplasia that define surgically treated epilepsy syndromes. The authors discuss future challenges to identifying and treating medically refractory epilepsy patients with cortical dysplasia.

Objective: Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time. Methods:Pediatric epilepsy surgery patients operated in the first 11 years (1986 -1997; pre-1997) were compared with the second 11 years (1998 -2008; post-1997) for differences in presurgical and postsurgical variables.Results: Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, ϩ16%), 1 (81%, ϩ18%), 2 (77%, ϩ19%), and 5 (74%, ϩ29%) years, and more seizure-free patients were on medications at 0.5 (97%, ϩ6%), 1 (88%, ϩ9%), and 2 (76%, ϩ29%), but not 5 (64%, ϩ8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery. Conclusions: Improved technology and surgical procedures along with changes in clinical practicewere likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients. Neurology Surgery for children with refractory epilepsy has become an important treatment option over the past 30 years. Initially, most patients were adolescents with focal lesions involving the temporal lobe similar to adult epilepsy surgery.1,2 With modern neuroimaging (e.g., MRI SPECT and fluorodeoxyglucose [FDG]-PET), the number of surgical centers expanded, as did etiologies and types of operations. Today, pediatric epilepsy surgery has evolved to include extratemporal operations and cerebral hemispherectomy for children of all ages. Etiologies range from cortical dysplasia, tumors, and perinatal strokes to rarer syndromes such as hemimegalencephaly, tuberous sclerosis complex (TSC), Rasmussen encephalitis, Sturge-Weber syndrome, and hypothalamic hamartomas.3 Many children are treated because they are at risk for epileptic encephalopathies. e-Pub ahead of print on April 28, 2010, at www.neurology.org. From the Departments of Neurosurgery (M.H., T.R.V., G.W.M.) and Neurology (H

MTLE/HS surgery is able to keep patients seizure free for almost up to two decades. Removal of the neocortex besides the mesial portion of the temporal lobe does not lead to better chances of seizure control. These findings are applicable to the typical unilateral MTLE/HS syndrome and cannot be generalised for all types of TLE. Future longitudinal randomised controlled studies are needed to replicate these findings.

Our findings show that undernourishment and seizures have an additive detrimental effect on body and brain weight as well as on spatial memory.

This study provides Class III evidence that selective posterior callosotomy reduces falls in patients with epileptic drop attacks.