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<jats:title>Abstract</jats:title><jats:p><jats:italic><jats:bold>Objective</jats:bold></jats:italic>. We retrospectively analysed the clinical features and prognostic factors of surgery in children with drug‐resistant epilepsy involving the Rolandic area, and the relationship between the stable compound muscle action potentials (CMAPs) of intraoperative neurophysiological monitoring (IONM) and good motor function outcomes postoperatively.</jats:p><jats:p><jats:italic><jats:bold>Methods</jats:bold></jats:italic>. A study was conducted on the clinical data of 91 patients with epilepsy who underwent epilepsy surgery involving the Rolandic area and IONM from November 2015 to February 2019.</jats:p><jats:p><jats:italic><jats:bold>Results</jats:bold></jats:italic>. In total, 91 patients were included in this study. The median age at seizure onset was 1.3 years old. The median age at surgery was 4.4 years old. Twenty‐seven patients (29.7%), with age at onset below three years old, had epileptic spasms. The central operculum was the most common surgical region in 52 patients (57.1%). The most common pathology was focal cortical dysplasia (FCD) in 67 patients. At the last follow‐up visit, 69 patients (75.8%) were seizure‐free. Interictal epileptiform discharges in the Rolandic area were associated with good seizure outcome (<jats:italic>p</jats:italic>=0.016). Out of 91 patients, successful IONM was performed in 88 patients (96.7%). Stable CMAP was seen in 79 of 88 patients (89.8%), and irreversible disappearance of CMAP was seen in nine patients (10.2%). New permanent motor deficit was observed in 13 of 88 patients (14.8%). There was a significant correlation between stable CMAP and good motor function outcome (<jats:italic>p</jats:italic>&lt;0.001).</jats:p><jats:p><jats:italic><jats:bold>Significance</jats:bold></jats:italic>. This is the largest reported cohort of children with drug‐resistant epilepsy involving the Rolandic area who received surgery from a single centre. Epileptic spasms were only observed in young children with age at onset below three years old. The major aetiology was FCD. The rate of seizure freedom was 75.8%. Epileptiform discharges in the Rolandic area were the main prognostic factor affecting surgical outcome. Stable CMAP can predict good motor function outcome postoperatively.</jats:p>

<jats:title>Abstract</jats:title><jats:p><jats:bold><jats:italic>Objective</jats:italic></jats:bold>. The spectrum of EEG abnormalities in the disconnected hemisphere in seizure‐free patients after hemispherectomy has not been well characterized.</jats:p><jats:p><jats:bold><jats:italic>Methods</jats:italic></jats:bold>. Fifty consecutive patients who were seizure‐free following hemispheric disconnection were identified. Data on preoperative clinical, EEG and neuroimaging findings and postoperative EEG findings and antiseizure medication status were collected.</jats:p><jats:p><jats:bold><jats:italic>Results</jats:italic></jats:bold>. Forty‐seven patients (94%) had functional hemispherectomy, and three (6%) had more extensive tissue resection of the posterior quadrant or frontal region along with hemispheric disconnection. Etiologies included: residual effects from vascular lesions including perinatal stroke in 35 patients, Rasmussen encephalitis in six, malformation of cortical development in seven, and Sturge‐Weber syndrome in two. Pre‐operative EEG showed focal epileptiform discharges in the affected hemisphere in 26 patients and in both hemispheres in 19. Eleven patients had diffuse bisynchronous epileptiform discharges. Postoperative EEGs at six to 12 months after surgery showed slowing and attenuation of physiological rhythms on the operated side in all patients. Thirty‐four patients (68%) had epileptiform discharges exclusively from the operated hemisphere, six (12%) had bilateral independent epileptiform discharges, nine (18%) had no epileptiform discharges on either side, and one (2%) had epileptiform discharges from the contralateral hemisphere only. Lateralized periodic discharges from the operated hemisphere were noted in three patients (6%). EEG seizures from the operated hemisphere without clinical signs were noted in four patients (8%). After a median follow‐up of three years, 30 patients (60%) were off all antiseizure medications, including 8/9 (89%) patients with no epileptiform discharges, 20/34 (59%) patients with postoperative epileptiform discharges from the operated hemisphere, and 2/7 (28%) patients with contralateral discharges.</jats:p><jats:p><jats:bold><jats:italic>Significance</jats:italic></jats:bold>. The majority of patients who are seizure‐free after disconnective hemispherectomy will continue to show epileptiform discharges in the operated hemisphere. The presence of such discharges should not preclude tapering, nor prompt restarting of antiseizure medication in seizure‐free patients.</jats:p>

<jats:title>Abstract</jats:title><jats:p>The ventral precuneal and posterior cingulate area (VP‐PC) represents a distinct but topographically variable mesial parietal site of epileptogenicity that may manifest as a common temporal lobe‐mediated ictal expression. In a review of records of 62 presumptive epilepsy surgery cases, two cases of primary epileptogenicity expressed within the VP‐PC were identified and are detailed to bring attention to this electroencephalographically‐hidden area of ictal expression. Details of their investigation and surgical treatment illustrate distinctly different approaches addressing the problem and bringing about a seizure‐free outcome.</jats:p>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>The aim of the study was to identify the predominant predictors of seizure relapse following discontinuation of ASM in epileptic children.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The study cohort consisted of 403 epileptic children who had a withdrawal process of ASM (monotherapy: 344; dual therapy or polytherapy: 59) after at least a 2‐year seizure‐free period. Patients were categorized if they had a well‐defined epileptic syndrome. Epileptic children with ongoing ketogenic diet, vagal nerve stimulation, or surgery were excluded from the cohort due to the additional withdrawal process related to other therapy modalities.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The cohort's seizure relapse rate was 12.7% (51/403). The highest rates of seizure relapse were defined for genetic etiology at 25% and structural etiology at 14.9%. An epilepsy syndrome was defined in 183 of 403 children (45.4%). There was no difference in the seizure relapse rate between the subgroups of well‐defined epileptic syndromes; 13.8% for self‐limited focal epileptic syndromes, 11.7% for developmental and epileptic encephalopathies, and 7.1% for generalized epileptic syndromes. Five predictors were defined as the most powerful predictors of seizure relapse in univariate analysis: age at epilepsy diagnosis &gt;2 years (hazard ratio [HR]: 1.480; 95% confidence interval [CI]: 1.134–1.933), defined etiology (HR: 1.304; 95% CI: 1.003–1.696), focal seizure (HR: 1.499; 95% CI: 1.209–1.859), ≤3 months duration of the withdrawal process (HR: 1.654; 95% CI: 1.322–2.070), and a history of neonatal encephalopathy with or without seizures (HR: 3.140; 95% CI: 2.393–4.122). In multivariate analysis, the main predictor of seizure relapse was a history of neonatal encephalopathy with or without seizures (HR: 2.823; 95% CI: 2.067–3.854).</jats:p></jats:sec><jats:sec><jats:title>Significance</jats:title><jats:p>The duration of seizure freedom before discontinuation of ASM was not a predominant risk factor for seizure relapse: 2–3 years versus &gt;3 years. The predictive values of five predictors of seizure relapse rate should be evaluated for patients with different epilepsy subgroups.</jats:p></jats:sec>

<jats:title>Abstract</jats:title><jats:p>Pupillary changes can be an important semiologic feature in focal epilepsy. Though the subcortical networks involving pupillomotor function have been described, cortical generators of pupillary dilation and constriction in humans are not well known. In this report, we describe a case of pupillary constriction occurring during seizures in a patient with drug resistant focal epilepsy. On stereoelectroencephalography, onset was noted within the posterior segment of the right intraparietal sulcus and direct cortical electrical stimulation of these electrode contacts reproduced pupillary constriction associated with habitual seizures. This is the first case report to describe ictal pupillary constriction during SEEG with confirmation of the cortical localization by direct cortical electrical stimulation. The posterior segment of the right intraparietal sulcus localization of pupillary constriction may aid in surgical evaluation patients with drug resistant focal epilepsy.</jats:p>