Sierra-Marcos A, et al. - Objectives of this study were to define electro-clinical and imaging findings in the presurgical evaluation of children with posterior cortex epilepsy (PCE), and to identify potential factors associated with surgical and cognitive outcomes. Accumulated data suggested that in children with drug-resistant PCE, epilepsy surgery needed to be considered, particularly in those with a restricted epileptogenic zone (EZ).

• A total of 55 patients had drug-resistant PCE, among patients referred to the Epilepsy Monitoring Unit of ‘Hospital Universitario Niño Jesús’ from 2003 to 2016.
• Among patients achieving seizure freedom after surgery (ILAE class 1) and patients with persistent seizures, different variables obtained from the multimodal presurgical work-up were analyzed.
• The authors compared categorical variables with Fisher's exact test and numeric variables with t-Student for independent samples.
• They used multiple logistic regression to analyze predictive values.

• Until surgery, median duration of epilepsy was 5 years [3-10 years].
• In this study, 50 patients demonstrated lesions in the MRI, and 62.5% had concordant MRI-PET corregistration.
• 37 (67%) patients were operated (lesionectomy in 21 subjects, tailored resection based on intracranial studies in 16), and 23 (62,2%) reached ILAE class 1, with a mean follow-up period of 3.51 [1–12] years.
• A lower number of basal seizures and antiepileptic drugs, a well-defined lesion on the MRI, an epileptogenic zone (EZ) restricted to the posterior quadrant and the normalization of postsurgical EEGs were correlated with seizure freedom (p < 0.05).
• Furthermore, the authors observed a long-term improvement of cognitive performances in 65% of patients.