First, Wyllie and colleagues have http://www.selleckchem.com/products/Dasatinib.html demonstrated that children or adolescents with abundant generalized or bilateral epileptiform discharges on EEG can be successfully treated with surgery in selected patients [9]. Second, Lee and coworkers have recently showed that, despite abundant generalized and multiregional EEG anomalies, resective epilepsy surgery can be successful in some children with LGS [13]. However, in the study of Lee et al., patients with contralateral ictal epileptic discharges were all excluded. Here, we are the first ever to report, to the best of our knowledge, that epilepsy surgery can also be considered in children or adolescents with LGS phenotype with contralateral ictal discharges.2. Methods2.1.

Diagnostic Criteria and EligibilityIn this retrospective chart study, we found that 52 patients during the period between 1997 and 2007 had LGS phenotype. Of them 18 patients underwent resective surgery and/or plus multiple-subpial transection (MST) and/or callosotomy. The defining characters of LGS used in the study were as follows: (1) multiple seizure types, mainly generalized, including tonic, atonic, and atypical absences; (2) primary and secondary SSW EEG discharges during wakefulness and paroxysmal fast activity (PFA) during sleep; (3) mental retardation.

Eligibility criteria for resective surgery included: (1) frequent (more than 4 times per month) and severe seizures interfering with the patient’s life; (2) seizures refractory to at least two AEDs and surgery was considered to be the last resort after extensive discussion with the families; (3) focal or multifocal lesions confirmed by imaging data (MRI or SPECT or CT scan); (4) EEG showing ictal or interictal hemispheric-dominant discharges, that is, more than 70% of the discharges originating from one hemisphere in both ictal and interictal periods, a lateralizing abnormality which coincides with imaging or SPECT findings; (5) surgically Carfilzomib accessible lesions, and the location of the lesions predicted that lesionectomy would cause no severe deficit; (6) parents’ and/or patients’ family had a reasonable understanding of the risks and benefits of the procedures. Duly-prepared informed consent forms were obtained. 2.2. Preoperative InvestigationAll patients in the study underwent a comprehensive evaluation including detailed history and neurological examination, routine and ambulatory EEG, long-term video EEG, and all satisfied the electroclinical criteria for LGS at least at some point in time.