To assess epilepsy surgery outcomes in children undergoing resective or disconnective procedures for epilepsy secondary to perinatal stroke.

There is limited data pertaining to surgical outcomes secondary to perinatal stroke. We hypothesize that resective or disconnective surgery for drug resistant epilepsy after a perinatal stroke result in a high cure rate.  

A scoping review was conducted following Levac 2010 and PRISMA checklist. Inclusion criteria included epilepsy surgery outcomes in perinatal stroke with ≥6-month postoperative follow-up and seizure outcome based on Engel/ILAE scale. Studies without perinatal stroke etiology or with neuromodulation procedures were excluded. Pooled proportional ratios were calculated to demonstrate a likelihood of favorable seizure control (Engel I/ILAE I–II) with heterogeneity assessed using I² statistics. Clinical variables such as surgery type, vascular territory, interictal-EEG, and semiology were analyzed when available.

Of 505 citations, 11 studies (129 patients) met inclusion criteria.  109 patients underwent surgical resection with a seizure freedom rate of 0.83 [95% CI: 0.75–0.92], with moderate heterogeneity (I² = 33.6%). Vertical parasagittal hemispherotomy [37 (33.9%)] was the most common surgical procedure, followed by lobectomy [22 (20.1%]. Nineteen patients underwent lobectomy or lesionectomy, and forty-nine had hemispherectomy or hemispherotomy; all achieved Engel I/ILAE I–II outcome. Of the 15 stroke patients with documented vascular distribution, all 15 patients [14 (MCA) and 1 (PCA)] achieved Engel I/ILAE I–II outcome. Among 22 patients with available inter-ictal EEG data, thirteen had unilateral and nine had bilateral epileptiform discharges, with no significant difference in seizure outcome. Eleven of 44 patients had focal seizures and twenty-one had focal-to-bilateral seizures; all achieved Engel I/ILAE I–II outcome. Five of the six patients with epileptic spasms achieved Engel I/ILAE I–II outcome.

Intractable epilepsy after a perinatal stroke can be cured by resective surgery, regardless of seizure type or presence of bilateral epileptiform discharges.