Epilepsy represents the most common neurological disease, its prevalence reaching up to 1%, and around 30% of patients become refractory to treatment. In these patients, epilepsy surgery is often their only chance for disease-free life. Aetiology of epilepsy is heterogenous; we recognize genetic, structural- metabolic epilepsy and epilepsy with unknown aetiology. Patients with focal pharmacoresistant epilepsy may become candidates for epilepsy surgery; the same does not apply to patients with metabolic or neurodegenerative disease. Multiple factors influence decision about epilepsy surgery, the most important ones being (i) the type of known or presumed structural lesion and (ii) the possibility to precisely delineate the epileptogenic zone (the area of seizure generation). Another factor that needs to be accounted for is the proximity of epileptogenic zone to the eloquent cortical areas (the areas with important neurological functions, e.g. motor or speech functions). Epilepsy surgery principally aims for complete removal the epileptogenic zone, and subsequently for complete freedom from seizures. Hypothesis on the localization of the epileptogenic zone arises from the combined information gained from various diagnostic, mostly neuroimaging, methods. Cognitive profile examination includes...

A epilepsia é uma desordem cerebral definida por pelo menos duas crises não provocadas ocorrendo em um intervalo maior que 24 horas, uma crise não provocada e uma probabilidade de futuras crises similar ao risco de recorrência geral depois de duas crises não provocadas (pelo menos 60%) nos próximos 10 anos; ou o diagnóstico de uma síndrome epiléptica. Após o diagnóstico do tipo de epilepsia, existem situações em que o paciente não responde ao tratamento medicamentoso, apresentando pelo menos uma crise epiléptica por mês por um período mínimo de 2 anos. Se durante esse período, dois ou três diferentes fármacos antiepilépticos foram utilizados em monoterapia ou politerapia, e o paciente não obtém controle das crises, configura-se o quadro de epilepsia farmacorresistente. A intervenção cirúrgica é uma opção para essas crianças, atuando no controle das crises e, potencialmente no desenvolvimento neuropsicomotor. Neste estudo, avaliamos as variáveis clínicas como a idade de início da epilepsia, duração da epilepsia, frequência de crises, etiologia e a Escala de Comportamento Adaptativo de Vineland (ECAV) para caracterizar aspectos referentes aos domínios da comunicação, socialização, habilidades diárias e habilidades motoras, no período pré e pós-operatório de cirurgia de epilepsia. A nossa intenção foi determinar o impacto da cirurgia de epilepsia no desempenho dos pacientes nessas esferas avaliadas pela ECAV. Como resultados, encontramos que o grupo de participantes livre de crises após a cirurgia de epilepsia apresentou melhor desempenho cognitivo na segunda avaliação pós-operatória, quando comparado ao grupo que não teve controle de crises. A variável clínica duração da epilepsia influenciou a equivalência etária e as pontuações padrão da ECAV no período pré-operatório, sendo considerada determinante para o atraso neuropsicomotor dos pacientes submetidos à cirurgia de epilepsia. Quanto aos fatores preditivos de melhora das crises pós-operatórias, observou-se que Engel e cirurgia foram as variáveis consideradas significativas. A maioria dos pacientes (63,9%) na segunda avaliação pós-operatória ainda apresentou convulsões ou não obteve melhora. Nos achados da investigação sobre o impacto das crises em relação ao desenvolvimento neuropsicomotor na primeira avaliação 21,3 meses após a cirurgia, foi observado um ganho abaixo do esperado de apenas 4,4 meses na equivalência etária, não evidenciando melhora em curto prazo após a cirurgia, independente do controle de crises. Após 41,3 meses do procedimento cirúrgico os pacientes que apresentaram controle de crises tiveram ganhos adaptativos significativos de 15 meses na equivalência etária quando comparados com os que não apresentavam controle das crises. Nesses últimos pacientes, a equivalência etária permaneceu praticamente estável com um incremento de apenas 3 meses quando analisada as fases pré e pós - operatória / Epilepsy is a disease of the brain defined by at least two unprovoked seizures occurring 24 h apart, one unprovoked seizure and a probability of further seizures like the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years or diagnosis of an epilepsy syndrome. After epilepsy diagnosis, there are situations where patients do not respond to drug treatment, developing one seizure per month for a minimum of 2 years. If during this period two or three antiepileptic drugs different used as monotherapy or in combination, a condition known as drug-resistant epilepsy. Epilepsy surgery is an option for children with drug-resistant epilepsy acting on the seizure control seizures and, potentially on neuropsychomotor development. In this study, we evaluated clinical variables such as epilepsy age of onset, epilepsy duration, seizure frequency, etiology and adaptive behavior scale of Vineland to characterize aspects related to age equivalence through the domains of communication, socialization, daily skills and motor skills pre- and post-surgical period. Our intention was to determine the impact of epilepsy surgery on the performance of patients in these areas evaluated by Vineland. Thus, we found that the seizure free group participants showed better cognitive performance in the second evaluation, compared to the group that not seizure controlled. The clinical variable duration of epilepsy influenced the age equivalence and standard Vineland scores in the preoperative period, being considered determinant for the neuropsychomotor delay of patients submitted to epilepsy surgery. Regarding the predictive factors of improvement of postoperative crises, it was observed that Engel and surgery were the variables considered significant. The majority of the patients (63.9%) in the second postoperative evaluation still had seizures or did not improve. The findings of the research on the impact of crises on neuropsychomotor were that in the first evaluation 21.3 months after surgery there was a below-expected gain of only 4.4 months of age equivalence, not showing improvement in the short term after surgery, independent of control crisis. After 41.3 months of the surgical procedure, the patients presenting with seizure control had significant adaptive gains of 15 months when compared to those without seizure control. In the latter patients, the age equivalence remained practically stable with an increase of o preoperative only 3 months, analyzing the phases pre and postoperative evaluation

Pacientes com epilepsia do lobo temporal farmacorresistente, frequentemente, possuem esclerose hipocampal como lesão epileptogênica. Muitas vezes, estes pacientes se beneficiam de lobectomia temporal para redução da ocorrência de crises epilépticas. Para que possam se submeter a este procedimento, é necessário o uso da videoeletroencefalografia prolongada para delimitação apurada da zona epileptogênica. Apesar dos avanços dos métodos diagnósticos nesta área, a busca por um instrumento que permita uma avaliação clara da chance de uma vida livre de crises após cirurgia permanece. No presente trabalho, a apresentação do padrão eletroencefalográfico ictal foi estudado, de forma a se pesquisar se existe relação entre a sua ocorrência e permanência em apenas um hemisfério cerebral com um melhor prognóstico pós-cirúrgico. Foram revisados os dados eletroencefalográficos ictais e os prontuários médicos de 284 pacientes. Procedeu-se à classificação de seus padrões eletroencefalográficos ictais em unilaterais ou bilaterais, e seu prognóstico após um, dois e cinco anos após cirurgia em livre de crise ou não livre de crise epiléptica. Apresentavam padrão unilateral 132 pacientes, e 152 apresentavam padrão bilateral. Estavam livres de crises 236 pacientes, e 48 ainda persistiam com crises epilépticas após cirurgia. Não houve associação entre padrões ictais unilaterais e uma vida livre de crises epilépticas após a cirurgia (diferença de 7,5%; p=0,092; chi-quadrado). Dessa forma, não se pode aplicar o padrão ictal eletroencefalográfico como ferramenta para predição de uma vida livre de crises após lobectomia temporal em pacientes com epilepsia da região mesial do lobo temporal associada à esclerose hipocampal. / Patients with drug-resistant temporal lobe epilepsy usually have hippocampal sclerosis as an epileptogenic lesion. Most of the times, these patients are benefited from temporal lobectomy for seizure relief. For this procedure to occur, a long-term videoelectroencephalogram is necessary for the accurate delineation of the epileptogenic zone. Despite the developments in the diagnostic methods on this area, the quest continues for an instrument that allows a clear evaluation of the chance to obtain a seizure-free life after epilepsy surgery. In the present study, the electroencephalographic ictal patterns were evaluated, and the relationship between its occurrence and permanence in one cerebral hemisphere and the possibility of a seizure-free outcome after surgery were compared. The ictal electroencephalografic and medical records of 284 patients were analyzed. A classification of ictal patterns, whether unilateral or bilateral, was issued, and the seizure outcome after one, two, and five years after surgery annotated. Unilateral ictal patterns occurred in 132 patients, and bilateral ictal patterns in 152. Seizure-free status was obtained in 236 patients, and 48 still persisted with seizures. There was no association between a unilateral ictal status and a seizure-free outcome after surgery (difference of 7.5%, p=0.092; chi-square). So, the electroencephalographic ictal pattern is not a valuable tool for predictions regarding seizure outcome in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis that are submitted to temporal lobectomy.

Ph.D. / Epilepsy is a multidimensional disorder that extends beyond the medical implications to impact nearly every aspect of the person's life, as well as the lives of the people in the surrounding environment. Intractable epilepsy has a poor prognosis with possible worsening of seizures and cognitive decline over time. Anterior temporal lobe surgery for epilepsy provides an opportunity for the alleviation of seizures; however there are potential risks, to memory in particular. Research on surgery outcome thus far has evaluated outcome from a linear paradigm and has studied impact of surgery on isolated areas of function, the results derived from this have been largely inconsistent. So far, there has been very little research that focuses on the person as a whole, and as yet there has been no integrated approach to studying surgical outcome. The aim of the current study was therefore to investigate the impact of anterior temporal lobe surgery, specifically the symptomatic and functional surgical outcomes, in an integrated and holistic manner. This was done in accordance with the paradigm of complex systems theory as a critique of the previous literature in this field, and to gain a more holistic understanding of surgical outcome. A combination of methodologies was employed in order to achieve this. The sample consisted of male (n=10) and female (n=24) patients with intractable epilepsy undergoing left-sided (n=13) and right-sided (n=21) temporal lobe surgery at the Milpark Hospital Johannesburg between the ages of 14 and 58 (mean = 39 years), over a period of seven years. A pretest-posttest design was employed to obtain quantitative data (n=34). Post surgical assessments were conducted up to seven years post surgery (mean=3.6 years). Pre and post surgery assessment included neurocognitive functioning, particularly memory and language functions, by means of the Rey Complex Figure Test, Wechsler Memory Scale-Ill, and Controlled Oral Word Association Test; as well as emotional functioning, particularly depression and anxiety, by means of the Beck Depression lnventory-11 and Beck Anxiety lnventory-11. The quantitative data was subjected to statistical analysis of the sample as a whole, as well as gender and side of surgery comparisons, and included tests of normality of distribution of the data; the paired samples t-test; the independent samples t-test; the Wilcoxon Signed Ranks test; the Mann-Whitney U test; and the Wilks' Lambda test. A semi-structured interview was also conducted (n=30) in order to obtain qualitative data on the functional (psychosocial) aspects of outcome. The interview included an assessment of postoperative seizure outcome; changes in daily activity functions; the client's report on positive and negative outcomes of surgery; quality of life changes and satisfaction with surgery. The qualitative data was analysed using the methods of open coding and axial coding. The results for neuropsychological function reflected known lateralization effects with memory showing auditory-verbal memory deficits after left-sided surgery; and visual (figural) memory deficits after right-sided surgery. Gender differences reflected known neuropsychological differences with female superiority in verbal fluency and a male advantage on visual-spatial tasks. Importantly, there was no relationship between neuropsychological deficit and decrements in daily activity functions, emotional functioning or quality of life. This indicates little impact of neuropsychological deficit post surgery and may be an indication of the effectiveness of the preoperative screening procedures. The results for emotional functioning showed a statistically significant improvement in the 'moderate/severe' depression and anxiety groups from pre to post surgery. This indicates a substantial improvement in both depression and anxiety for this severity group. The qualitative results showed that surgery rendered 74% of the sample seizure free, 15% showing worthwhile improvement, and 11% no change or worse seizures. Seizure outcome however did not determine quality of life changes, even those with some improvement or no change still reported an improvement in quality of life post surgically. The functional outcomes showed little postoperative change in daily activity functions (driving, occupational functioning and marital status) but still a reported improvement in quality of life. There were far more reports on perceived positive than negative outcomes. The most positive benefit of surgery, as reported by participants, was that of increased feelings of control, decreased helplessness, and less anxiety and worry of having seizures. The overwhelming majority of participants reported improved quality of life (90%) and satisfaction with surgery (93%).

Orientador: Fernando Cendes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T20:41:16Z (GMT). No. of bitstreams: 1 Barbosa_PatriciaHorn_D.pdf: 4694168 bytes, checksum: 4b2bdfa4847274a2d3a88005c77669d2 (MD5) Previous issue date: 2015 / Resumo: Epilepsia de lobo temporal resulta com freqüência em refratariedade ao tratamento medicamentoso. Alguns fatores prognósticos da epilepsia focal e seu tratamento já foram descritos, mas outros ainda estão por ser melhor conhecidos. Nosso objetivo foi investigar associação entre alterações no EEG pré e pós-operatório e na ressonância de crânio pré-operatória com o resultado cirúrgico de pacientes com epilepsia de lobo temporal. Pacientes com epilepsia focal refratária submetidos a cirurgia após investigação não invasiva foram reavaliados. Calculamos o período livre de crises até a recorrência. Realizamos análise visual da RM crânio pré-operatória buscando sinais de atrofia hipocampal e alterações sutis no hipocampo contralateral. Revisamos exames de EEG pré e pós-operatórios buscando inicialmente a presença ou ausência de descargas epileptiformes. Posteriormente, quantificamos atividade epileptiforme interictal e buscamos associação com recorrência de crises. Utilizamos os testes estatísticos qui-quadrado e Fisher, quando adequados, e construímos curvas de sobrevivência de Kaplan-Meier, considerando recorrência de crises como desfecho, com comparação pelo método de Mantel. Na primeira parte do estudo foram incluídos 86 pacientes com atrofia hipocampal. EEG pré-operatório unilateral não se associou a resultado cirúrgico favorável; EEG pós-operatório com presença de atividade epileptiforme interictal não se associou a resultado cirúrgico desfavorável; RM cranio com hipocampo contralateral alterado se associou tanto a resultado cirúrgico desfavorável, quanto com bilateralidade nos EEGs pré-operatórios. Na segunda parte do estudo, com 129 pacientes incluídos, não encontramos associação significativa entre presença de atividade epileptiforme interictal no EEG pós-operatório e resultado cirúrgico. As curvas de sobrevivência dos grupos com descargas epileptiformes presentes versus ausentes não foram estatisticamente diferentes (p=0,09), porem observamos uma tendência, o que motivou a terceira parte. Desta forma, demonstramos, através da quantificação da atividade epileptiforme, associação entre descargas pouco frequentes no EEG pós-operatório com resultado cirúrgico favorável. Finalmente, na tentativa de estabelecer o EEG pós-operatório como preditor de recorrência de crises, não encontramos, com a amostra disponível, associação entre EEG pós-operatório com atividade epileptiforme pouco frequente e resultado cirúrgico favorável. Estes resultados demonstram que é importante valorizar alterações sutis no volume, conformação, eixo e sinal do hipocampo menos afetado na indicação de cirurgia de pacientes com epilepsia de lobo temporal e atrofia hipocampal. O resultado cirúrgico dos pacientes com hipocampo contralateral normal é mais favorável. Alteração eletrográfica bitemporal no EEG pré-operatório, em geral, está associada a alteração estrutural sutil no hipocampo contralateral, que muitas vezes não é valorizada. Tal achado corrobora evidências previamente descritas de que pacientes com EEG pré-operatório bitemporal tem prognóstico cirúrgico menos favorável. Os dados relacionados à análise quantitativa de descargas epileptiformes no EEG pós-operatório mostraram associação entre atividade epileptiforme e resultado cirúrgico. Tal achado sugere que o EEG pode ser uma ferramenta útil no seguimento clínico pós-operatório. Em conclusão, nossos resultados indicaram dois fatores importantes no prognóstico de controle de crises após cirurgia em ELT: presença de alteração hipocampal contralateral mesmo que sutil, e espículas em uma frequência maior que 4 por um período de 15 minutos / Abstract: Temporal lobe epilepsy is frequently linked to medical refractoriness. Many clinical prognostic data on focal epilepsy have repeatedly been described, while surgical outcome factors are yet to be fully known. We presently look into an association between interictal epileptiform discharges in pre and postoperative EEG, as well as preoperative brain magnetic resonance imaging, and surgical outcome of temporal lobe epilepsy. Patients with medically refractory focal epilepsy submitted to surgery following non invasive investigation were reassessed. We calculated time until seizure recurrence. We visually analysed preoperative MRI searching for signs of hipoccampal atrophy, as well as subtle contralateral hipoccampal changes. We reviewed pre and postoperative EEGs concerning presence or absence of interictal epileptiform discharges. Later on, we quantified interictal discharges and tested association with seizure freedom. We used chi square or Fisher¿s exact test, when most adequate. We also built Kaplan-Meier¿s survival curves setting seizure recurrence as endpoint, and compared curves by Mantel method. We initially included 86 patients with hipoccampal atrophy. Preoperative unilateral EEG was not associated with favorable surgical outcome; presence of IED in postoperative EEG was not associated with unfavorable outcome; contralateral hipoccampal changes on preoperative MRI was strongly associated with unfavorable surgical outcome, as well as with bilateral preoperative EEGs. We then studied postoperative EEGs of 129 individuals. There was not a significant association between postoperative EEG and surgical outcome. Survival curves of group of patients with interictal discharges present and absent were not statistically different (p=0.09), but we observed a tendency in that direction. Therefore, we were able to demonstrate through manual quantification of epileptiform discharges that postoperative EEG direct association with surgical outcome. Our ultimate goal was to establish postoperative EEG as predictor of seizure recurrence. Unfortunately we were not able to demonstrate it with data available on our sample. These results highlight importance of assessing subtle changes in volume, form, axis and signal intensity on contralateral hipoccampus prior to indication of surgery in patients with temporal lobe epilepsy with hipoccampal atrophy. Surgical outcome is more favorable when contralateral hipoccampus is normal. Bilateral discharges over temporal electrodes in pre-operative EEG are associated with subtle structural changes on contralateral hipoccampus, which may be underestimated. Such findings is in agreement with previously described evidence of bitemporal preoperative EEG associated with less favorable surgical outcome. Quantification data on postoperative EEG sets forth direct association with epileptiform discharges and surgical outcome. Such finding suggests EEG may be a useful tool in postoperative followup. In conclusion, our results indicate two important prognostic factors for seizure control in surgically treated temporal lobe epilepsy patients: presence of contralateral signs of hipoccampal sclerosis, even if subtle, and interictal epileptiform discharges occuring in a frequency higher than 4 at 15 minutes period / Doutorado / Neurociencias / Fisiopatologia Médica

No description available.

Epilepsy affects approximately 0,5-1% of children. Epileptic seizures originate in and propagate along certain neural pathways involved in physiological processes of cognition. Consequently, cognitive impairment frequently accompanies epilepsy in childhood and contributes to diminished quality of life of these patients.The main goal of this PhD thesis was to study multiple aspects of cognitive impairment in children suffering from intractable focal epilepsy. In the first and primary study, we described for the first time the negative impact of quasi- periodic epileptiform discharges in sleep (termed "hurdles" in our work) on cognitive functions in children with focal structural epilepsy. We have also shown that epileptiform activity in sleep has a more prominent negative impact on cognitive functions than epileptiform activity in wake. Although "hurdles" are by definition generalized, they do not predict worse outcomes of epilepsy surgery, compared to controls. In the second study, we analyzed the relationship between the extent of epileptogenic zone, functional brain plasticity (evaluated by fMRI) and cognitive dysfunction in children with drug resistant temporal epilepsy. Comparing patients with isolated focal cortical dysplasia (FCD) and patients with combined pathology (FCD and hippocampal...

Cette thèse vise à approfondir nos connaissances sur le développement du langage dans le contexte de la chirurgie de l'épilepsie chez l'enfant. Nos objectifs étaient: (1) de dégager les répercussions de l'épilepsie pharmacorésistante sur le développement langagier, (2) de spécifier les profils langagiers selon le côté de l'épilepsie ou la localisation de la résection, (3) de mettre en évidence les capacités de réorganisation fonctionnelle et ses limites après la chirurgie de l'épilepsie. Trois études neuropsychologiques ont été conduites auprès de 53 enfants présentant une épilepsie pharmacorésistante ou ayant bénéficié d'une chirurgie. Nos résultats montrent que la trajectoire développementale peut être durablement modifiée, constituant un argument en faveur d’une période critique du développement du langage. Des troubles langagiers ont pu être observés quel que soit le côté de l’épilepsie, traduisant une probable dominance atypique du langage, les troubles étant toutefois plus sévères et plus fréquents en cas d’épilepsie gauche. Les performances langagières étaient corrélées avec l’adaptation comportementale. Le pronostic langagier en postopératoire apparaissait dans l’ensemble favorable, avec tout de même deux facteurs de risque : une limitation intellectuelle en préopératoire et la présence d’une sclérose hippocampique. Les patterns de déficits observés refléteraient l’implication des deux hémisphères pour les processus lexico-sémantiques ainsi que la spécialisation hémisphérique gauche pour les processus morphosyntaxiques. Par ailleurs, des profils langagiers distincts selon la localisation de la résection, frontale (fragilités sur le plan morphosyntaxique et métaphonologique) ou temporale (fragilités sur le plan lexico-sémantique), reflètent la spécialisation fonctionnelle des aires cérébrales sous-tendant le langage et les limites de leur réorganisation dans le contexte de l’épilepsie. Ces études démontrent l’enjeu d’une évaluation détaillée pour mettre en évidence des profils langagiers spécifiques, permettant ainsi d’affiner les axes de rééducation et d’orientation scolaire de ces enfants. / The aim of the present thesis is to improve our knowledge on the development of language in the context of epilepsy surgery. Our aims were: (1) to highlight the impacts of drug-resistant epilepsy on the development of language, (2) to specify the linguistic profile depending on epilepsy side or resection topography, (3) to emphasize the abilities of functional reorganization and its limits after epilepsy surgery. Three neuropsychological studies were conducted in 53 children who suffer from drug-resistant epilepsy or who underwent a surgery. Our results show that developmental trajectory can be modified for the long term, which states as an essential key for critical period of language development. Linguistic deficits were observed whatever the side of epilepsy was, resulting probably of atypical organization of language. However deficits were more frequent and more severe in left-side epilepsy. Language scores were correlated with behavioral adaptation. Linguistic prognosis at postsurgery seems on the average positive but two risk factors appeared: intellectual limitation at presurgery and hippocampal sclerosis. The pattern of deficits may reflect the implication of both hemispheres for lexico-semantic process and the left specialization for morphosyntactic process. In addition, different linguistic profiles were highlighted depending on the topography of resection: weaknesses in morphosyntactic skills and phonological awareness in case of frontal resection and weaknesses in lexico-semantic skills in case of temporal resection. This reflects functional specialization of language cortical areas and the limits of their reorganization in the context of epilepsy. These studies demonstrate the stakes of exhaustive assessment to highlight specific linguistic profiles that allow refining the lines of remediation and academic education of these children.

No description available.

Purpose While epilepsy surgery has been shown to reduce seizure frequency and severity and even cures seizures in children with drug-resistant epilepsy, data from middle-income countries (MIC) are lacking. Method This study is a retrospective review of children with drug-resistant epilepsy who underwent surgical treatment at Red Cross War Memorial Children's Hospital (RCWMCH) between 1 January 2000 and 31 December 2021 (HREC: 140/2020). Results During the 21-year study period, 60 patients underwent epilepsy surgery for drugresistant epilepsy. The median age of the children was seven years (IQR 4.81-10.27years) at the time of surgery, with a male predominance of 33 patients. The most common surgical procedure performed was an anterior temporal lobectomy for temporal lobe epilepsy in 19 cases (31.7%), followed by peri-insular hemispherotomy in 9 cases (15.0%) and frontal lobectomy in 8 cases (13.3%). Of the 60 patients, complete records were available for 55 patients noting complications in 11 (20.0%), of which 4 cases (7.3%) had major complications. Notably, 2 patients (3.6%) had new-onset psychiatric symptoms. The long term outcomes after surgery showed 1-year seizure freedom in 32 patients (58.2%); among these, 21 patients (38.2%) could stop ASM one year after surgery, 17 patients (30.9%) had a recurrence of their seizures, and three had to restart ASM after 2-3 years. Eight patients (14.5%) required repeat surgery. The one-year-Modified Engel scoring for the study population was: 1-A in 52.7%, I-B in 3.6%, I-C in 1.8%, II-A in 15.8%, III-A in 10.9%, IV-A in 3.6% and IV-B in 10.9%. The most common histological finding in anterior temporal lobectomy (ATL) was focal cortical dysplasia (FCD), found in 11 patients (57.9%). The periinsular hemispherotomy (PIH) cases had equal numbers of FCD and Rasmussen's encephalitis in 4 patients (44.4%). The number of FCD in this series is much higher than in international data. Conclusion Epilepsy surgery is an effective and attainable intervention for drug-resistant epilepsy in the paediatric population despite limited resources and challenging aetiological profiles. Low complication rates were comparable to international data, with good seizure freedom outcomes.