6 Figure 7: T2W Axial MRI image of a 5-year-old boy who presented with intractable epilepsy secondary to postencephalitic sequelae (PES) causing damage to the right side. incomplete disconnection, and this patient was lost to follow up. All patients with RE had a Class I seizure outcome as this disease also strictly aﬀects only one hemisphere. However, the seizure outcome in patients with HM was not satisfactory as described in literature, and this has been reported in other series too [9, 17–21]. The likely explanation could be the presence of migrational abnormalities in the so-called “preserved hemisphere” or early development of an epileptic encephalopathy, already in utero [9]. 4.2. Social and Adaptive Outcome. Our data with respect to cognitive outcome has been published earlier [12]. We found a signiﬁcant gain in the mental and social age in the immediate postsurgical period which continued into the second and third years of followup. Our study [12] also showed that older age of onset of seizures showed positive mental and social age gains at followup. This ﬁnding is also supported by other studies [3, 24]. Onset of intractable epilepsy within the ﬁrst 24 months of life is a signiﬁcant risk factor for mental retardation, especially if seizures occur daily [12, 24]. Most of these children have a low DQ/IQ to begin with and the improvement in cognitive skills after surgery is poorer in these children. Furthermore, our study [12] also showed that a shorter duration of seizures prior to surgery is predictive of positive mental and social age gains, a ﬁnding that is in keeping with those of Freitag and Tuxhorn [22] and Basheer et al. [21]. In general, children with IE in our country are not exposed adequately to environmental stimuli as schooling is discontinued in the presence of seizures [12]. With good postoperative seizure control, the child’s attention capacities increase and they engage in social interaction with their family and peers. An improved school attendance due to seizure freedom improves their adaptive skills that in turn helps the child improve his performance in activities of daily living [12]. 5. Conclusion In our experience, over 90% of children with hemispheric and subhemispheric epilepsy syndromes achieve an excellent International Journal of Pediatrics seizure outcome with less morbidity following epilepsy surgery. Age of seizure onset and etiology of the disease caus- ing epilepsy are independent predictive variables of a good seizure outcome. Following seizure freedom, improvement of function in the residual brain occurs that in turn leads to improvement in adaptive and social functions and quality of life. Conﬂict of Interests The authors do not report any conﬂict of interests con- cerning the materials or methods used in this study or the ﬁndings speciﬁed in this paper. References [1] H. A. H. Robert, “Seizures in childhood,” in Nelson Textbook of Pediatrics, R. E. Behrman, R. M. Kliegman, and H. B. Jenson, Eds., pp. 1813–1825, WB Saunders, 16th edition, 2000. [2] K. Radhakrishnan, J. D. Pandian, T. Santhoshkumar et al., “Prevalence, knowledge, attitude and practice of epilepsy in Kerala, South India,” Epilepsia, vol. 41, no. 8, pp. 1027–1035, 2000. [3] J. H. Cross, “Epilepsy surgery in childhood,” Epilepsia, vol. 43, no. 3, pp. 65–70, 2002. [4] R. T. Daniel, S. G. Thomas, and M. Thomas, “Role of surgery in epilepsy,” Indian Pediatrics, vol. 44, no. 4, pp. 263–273, 2007. [5] J. Janszky, G. Ra´sonyi, A. Fogarasi et al., “Surgically treatable epilepsy—a review,” Orvosi Hetilap, vol. 142, no. 30, pp. 1597– 1604, 2001. [6] R. T. Daniel, K. Meagher-Villemure, J. P. Farmer, F. Ander- mann, and J. G. Villemure, “Posterior quadrantic epilepsy sur- gery: technical variants, surgical anatomy, and case series,” Epilepsia, vol. 48, no. 8, pp. 1429–1437, 2007. [7] R. T. Daniel, K. S. Babu, R. Jacob, and J. G. Villemure, “Pos- terior Quadrantic Resection and Disconnection,” in Pediatric Epilepsy Surgery, Preoperative Assessment and Surgical Treat- ment, O. Cataltepe and G. I. Jallo, Eds., pp. 196–204, Thieme Medical, 1st edition, 2008. [8] V. C. Terra-Bustamante, L. M. Inuzuka, R. M. F. Fernandes et al., “Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients,” Child’s Nervous System, vol. 23, no. 3, pp. 321–326, 2007. [9] J. G. Villemure and R. T. Daniel, “Peri-insular hemisphero- tomy in paediatric epilepsy,” Child’s Nervous System, vol. 22, no. 8, pp. 967–981, 2006. [10] J. Schramm, T. Kral, and H. Clusmann, “Transsylvian keyhole functional hemispherectomy,” Neurosurgery, vol. 49, no. 4, pp. 891–901, 2001. [11] O. Delalande, C. Bulteau, G. Dellatolas et al., “Vertical parasag- ittal hemispherotomy: surgical procedures and clinical long- term outcomes in a population of 83 children,” Neurosurgery, vol. 60, no. 2, supplement 1, pp. S19–S32, 2007. [12] S. G. Thomas, R. T. Daniel, A. G. Chacko, M. Thomas, and P. S. S. Russell, “Cognitive changes following surgery in intractable hemispheric and sub-hemispheric pediatric epilepsy,” Child’s Nervous System, vol. 26, no. 8, pp. 1067–1073, 2010.