SD 4.18 3.84 269.29 3.39 17.97 4 1 4 14 17 10 17 6 21 25 6 Mean 6.43 0.07 6.50 2.05 35.00 SD 7.64 0.03 2.12 2.75 0.01 Engels Class I (n = 31) n % 20 64.5% 11 35.5% 11 35.4% 11 35.4% Engels Class II–IV (n = 3) n % 2 66.7% 1 33.3% 0 0% 1 33% 12.9% 3.2% 12.9% 45.2% 54.8% 37% 63% 22.2% 77.8% 80.6% 19.4% 0 2 0 2 1 1 1 0 2 3 0 0% 66.7% 0% 66.7% 33.3% 50% 50% 0% 100% 100% 0% −0.76 −2.15 −0.17 −1.12 −1.41 0.006 14.23 0.50 0.13 0.56 0.70 P Value 0.44 0.03 0.86 0.26 0.15 0.94 0.007 0.46 0.71 0.45 0.40 International Journal of Pediatrics Table 2: Presurgery predictors of age, seizures, and cognition on postsurgery seizure outcome. Engels Class I (n = 31) Engels Class II–IV (n = 3) Statistics Z value Table 3: Presurgery predictors of gender, disease, and type of surgery on postsurgery seizure outcome. Statistics χ2 P Value 4 Variables Age at the time of surgery Age of seizure onset Frequency of seizures/day Total duration of seizures before surgery IQ/DQ (pre op) Variables Gender Disease Side Status epilepticus (pre-op) Epilepsia partialis continua (pre-op) Type of surgery Mean 8.10 4.078 113.33 4.11 59.20 Male Female RE IHSS SWS HM PES Right Left Yes No Yes No PIH PIPQ who had RE, SWS, PES, and IHSS had good seizure outcomes following surgery. 3.3. Cognitive Outcome and Their Predictors. The results of our cognitive outcomes that have been published before [12] show that the mental and social age showed a steady increase after surgery. However, in the long term, intelligence quotient (IQ) showed only a gradual gain on followup. Older age of onset of seizures and a shorter duration of seizures prior to surgery were predictive of positive cognitive gains following surgery [12]. 3.4. Complications. Complications in this series included pseudomeningocele in 2 (5.8%) and low pressure hydro- cephalus in 1 (2.9%) who required a low pressure ventricu- loperitoneal shunt. This is quite low as compared to other published series (Table 4) [9–11]. We also had 15 patients who developed postoperative fever, but CSF cultures were sterile. This could have been due to an aseptic meningitis due to the presence of blood products in the disconnected cavity. 4. Discussion 4.1. Seizure Outcome. Intractable epilepsy due to hemi- spheric/subhemispheric epilepsy respond well to PIH or PIPQ. Our series documents 91.1% seizure freedom, which is similar to other published studies [9, 12, 16–21]. Following functional hemispherectomy, seizure free outcomes have ranged from 52 to 90% [9, 16–21]. This range could be explained by diﬀerences in patient selection or tech- nical pitfalls such as incomplete removal in anatomical hemispherectomy and incomplete disconnection in func- tional hemispherotomy [14, 19]. We found the age of seizure onset to be a strong predictor of seizure freedom (Table 2). This ﬁnding is also supported by other studies [3, 22, 23]. A younger age of seizure onset is usually seen in children with developmental cortical malformations and multifocal epilepsy, which are proven to have poor seizure control [3]. The etiology of the disease producing epilepsy is also a strong predictor of seizure freedom (Table 3). This has been shown in other studies as well [12, 18–22]. The best results in our series were obtained in children suﬀering from RE, SWS, PES, and IHSS (Table 3). IHSS and SWS are seen in the perinatal age group, and they are generally unilateral with complete sparing of the opposite side. There has been evidence to support that in such cases, early surgical intervention facilitates good seizure control and helps the uninvolved hemisphere to develop and take over the functions of both sides [4]. However, in one patient with IHSS, we had a Class II seizure outcome and this was in the initial part of the series, which could be attributed to