Frequency and Significance of Acute Postoperative Seizures Following Epilepsy Surgery in Children and Adolescents

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Abstract
Summary: Purpose: To determine the frequency and prognostic features of acute postoperative seizures (APOSs), within the first postoperative week, in a group of children undergoing surgery for the treatment of medically refractory epilepsy. Methods: Patients younger than 18 years who underwent surgery for the relief of medically intractable epilepsy at the Mayo Clinic between 1985 and 1998 with a minimum of 12 months of follow‐up were eligible. A retrospective chart review was conducted to abstract information regarding demographics, epilepsy history, and preoperative, intraoperative, and postoperative risk factors, APOSs, and outcome. A multivariate analysis was conducted to control for confounding variables. Results: The study group was composed of 148 patients (mean age at surgery, 13 years; range, 5 months to 18 years). Twenty‐five percent of patients experienced APOSs. Risk factors associated with a statistically significant (p < 0.05) greater likelihood of experiencing APOS were non–complex partial seizure type, extratemporal surgery, postoperative fever, non–temporal lobe epilepsy, and postoperative interictal epileptiform activity. At last follow‐up, patients who did not experience APOSs had a significantly greater chance of being seizure free (80 vs. 51%; p < 0.001). With a multivariate analysis, APOS was found to be an independent predictor of outcome. Conclusions: This study indicates that APOSs are predictive of a less favorable outcome in the pediatric postsurgical patient; however, 51% remained seizure free at last follow‐up. Finally, the effects of APOSs on outcome were shown to be stable over a 12‐month follow‐up period.