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John D. Rolston, Dario J. Englot, Doris D. Wang, Tina Shih, and Edward F. Chang

E pilepsy affects nearly 1 in 100 people, leading to substantial morbidity, mortality, and economic burden. 2 , 17 , 18 Up to one-third of these patients are not helped by antiepileptic medications. 17 , 18 For patients with medically refractory epilepsy, a potentially curative option is resection of the epileptic foci when they can be clearly delineated and safely resected. 27 However, many patients are not suitable candidates for resection, and morbidity exists for surgery. 3 , 16 Because of this, there is a substantial need for additional treatment

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Dario J. Englot, David Ouyang, Doris D. Wang, John D. Rolston, Paul A. Garcia, and Edward F. Chang

F ocal epilepsy is a common and debilitating neurological disorder. Seizures are refractory to AEDs in 20%–40% of patients with epilepsy, leading to cognitive impairment, diminished quality of life, and increased risk of death. 3 , 6 , 18 Evaluation for surgical therapy is the standard of care for patients with localized, medically refractory epilepsy, as resection results in seizure freedom in two-thirds of patients with TLE and in one-third to one-half of patients with frontal lobe epilepsy. 19 , 28 In 2001, a randomized controlled trial of patients

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Dario J. Englot, John D. Rolston, Doris D. Wang, Kevin H. Hassnain, Charles M. Gordon, and Edward F. Chang

rate of resistance to antiepileptic medications and our poor ability to localize epileptic foci for resection. 15 Given the 500,000 yearly admissions to US hospitals for TBI, there is a dire need for improved treatment strategies for PTE. Here, we analyzed a large, prospectively collected registry of patients with medically refractory epilepsy who had received VNS therapy, and we compared seizure outcomes in patients with PTE versus non-PTE using a case-control study design. The specific type of injury was not specified for the registry data, so the analysis applies

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Dario J. Englot, John D. Rolston, Doris D. Wang, Peter P. Sun, Edward F. Chang, and Kurtis I. Auguste

recommendation that pediatric patients with intractable TLE or other medically refractory epilepsy syndromes be referred to a comprehensive epilepsy center for surgical evaluation. Furthermore, surgery should be considered in some cases of medically controlled lesional TLE, such as for tissue diagnosis in tumor cases, rupture risk with vascular malformations, notable growth and mass effect, or in a setting of significant toxicity or side effects from AEDs. In the present study, we also observed that significant predictors of postsurgical seizure freedom in pediatric TLE