382 Association of ECOG and Post-operative Seizure Freedom in Resective Pediatric Epilepsy Surgery

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INTRODUCTION: Epilepsy is a disorder that affects many adults and children within the United States. intraoperative electrocorticography (iECoG) is a method for surgeons to ensure an entire epileptogenic zone is resected for lesional epilepsy. Clarifying the utility of ECoG will better inform clinical practices for patients undergoing epilepsy surgery, especially in the pediatric population. METHODS: We conducted a retrospective analysis of 115 patients at the pediatric hospital. We assigned subgroups based upon extent of resection in concordance with iECoG findings. Group A had resections without epileptiform activity at margin. Group B had persistent epileptiform activity on ECoG after resection and further resection was thus performed. Group C had persistent epileptiform activity at margin, but further resection was contraindicated due to presence of eloquent cortex. RESULTS: Seizure freedom was achieved in 64% (n = 74) of all patients post-operatively; however, there was no statistically significant difference in seizure freedom (International League Against Epilepsy class 1C or better) at the 1-year follow-up or anti-seizure medication reduction between the three groups. Notably, there was also no correlation between each patient group and transient or long-term postoperative complications, such as unexpected postoperative deficits, infection, or symptomatic intracranial hemorrhage. CONCLUSIONS: We found no statistically significant difference between Groups A, B and C in regard to postoperative seizure reduction and freedom. While iECoG provides a biomarker for the purposes of resection, it is an imperfect proxy and may not be suitable as standard of care given its mixed results.

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