Hindawi Publishing Corporation International Journal of Pediatrics Volume 2012, Article ID 527891, 7 pages doi:10.1155/2012/527891 Clinical Study Outcomes of Disconnective Surgery in Intractable Pediatric Hemispheric and Subhemispheric Epilepsy Santhosh George Thomas,1 Ari George Chacko,1 Maya Mary Thomas,2 K. Srinivasa Babu,3 Paul Swamidhas Sudhakar Russell,4 and Roy Thomas Daniel5 1 Division of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India 2 Division of Pediatric Neurology, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India 3 Division of Neurophysiology, Department of Neurological Sciences, Christian Medical College, Vellore 632004, India 4 Department of Child and Adolescent Psychiatry, Christian Medical College, Vellore 632004, India 5 Division of Neurosurgery, Department of Clinical Neurosciences, CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland Correspondence should be addressed to Roy Thomas Daniel, roy.daniel@chuv.ch Received 31 July 2011; Revised 2 November 2011; Accepted 2 November 2011 Academic Editor: Alan Richard Spitzer Copyright © 2012 Santhosh George Thomas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy. Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel’s classiﬁcation and cognitive skills by appropriate measures of intelligence that were repeated annually. Results: There were 34 patients in all. Epilepsy was due to Rasmussen’s encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome. Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome. 1. Introduction Seizures are the most common neurological events of child- hood with approximately 3–5% of children experiencing a seizure at some point in their lives 25% of whom subsequently go on to develop epilepsy [1]. The prevalence of epilepsy in India is 4.9 to 6.2 per 1000 population. Of these patients with epilepsy, 43% comprises of children and adolescents at least two antiepileptic drugs (AEDs) given over at least a two-year period [3]. A single deﬁnition for “intractable” epilepsy cannot suit all situations as def- initions of intractability are individualized to the patient. Of these patients deemed to be intractable, approximately 50% are estimated to have surgically remediable epilepsy [4, 5]. “Hemispheric Epilepsy” (HE) refers to epileptiform activity in all four lobes of one hemisphere, and when it involves more than two lobes of the brain, it is termed “subhemispheric epilepsy” (SHE) [4, 6, 7]. These hemi- spheric brain lesions are commonly associated with early onset of catastrophic epilepsies and multiple seizure types that inhibit brain development. These respond well to early hemispheric/subhemispheric disconnective/resective surg- eries [6–9]. 2. Patients and Methods An analysis was done of the pre- and postsurgical data of 34 children who underwent disconnective epilepsy surgeries, that is, a peri-insular hemispherotomy (PIH) or a peri- insular posterior quadrantectomy (PIPQ) for hemispheric/ subhemispheric epilepsy from April 2000 to March 2011. The following were the selection criteria.