Epilepsy and paroxysmal conditions

Advanced search

Surgical treatment of MRI-negative drug resistant epilepsy in children


Objective: analysis of treatment tactics for patients with magnetic-resonance-imaging (MRI) negative epilepsy, characteristics of morphological data and assessment of the treatment results.

Material and methods. Within the period of 2013–2021, 31 patients under the age of 18 with drug-resistant nonlesional epilepsy were examined according to the “epilepsy” MRI-protocol. Patient distribution by gender, age, duration of illness, age of onset, number of anticonvulsant protocols, frequency of seizures at the time of initiated treatment, side and lobe of the seizure generation zone was analyzed. The instrumental diagnostic methods were noted in a specially designed study form and reported contribution of relevant result to epileptogenic zone. The distribution of patients according to surgical intervention and histological data was also analyzed.

Results. Resection surgery was carried out in 26 (83.9%) patients. Palliative operations were performed in 5 (16.1%) cases with bilateral localization of the epileptic focus: callosotomy (3) and vagal nerve stimulation (2). Twelve months post-therapy outcomes by Engel class I were found in 19 (61.3%) patients, class II – in 6 (19.4%), class III – in 5 (16.1%), and class IV – in 1 (3.2%). Long-term results of surgical treatment were assessed 3 and 5 years later.

Conclusion. Surgery of MRI-negative epilepsy can be effective with seizure-free outcome in 61.3% of cases, but requires use of additional diagnostic methods in relation to standard pre-surgery examination to localize epileptogenic zone.

About the Authors

M. R. Mamatkhanov
Almazov National Medical Research Centre
Russian Federation

Magomed R. Mamatkhanov – Dr. Med. Sc., Senior Researcher, Research Laboratory of Pediatric Neurosurgery

Saint Petersburg

RSCI SPIN-code: 7426-2245.

V. V. Ushanov
Almazov National Medical Research Centre
Russian Federation

Vseslav V. Ushanov – Clinical Resident, Chair of Neurosurgery

Saint Petersburg

A. P. Gerasimov
Almazov National Medical Research Centre
Russian Federation

Alexandr P. Gerasimov – MD, Senior Researcher, Research Laboratory of Pediatric Neurosurgery

Saint Petersburg

RSCI SPIN-code: 9108-9354

W. A. Khachatryan
Almazov National Medical Research Centre
Russian Federation

William A. Khachatryan – Dr. Med. Sc., Professor, Head of Research Laboratory of Pediatric Neurosurgery

Saint Petersburg, Russia

WoS ResearcherID: G-4002- 2018;

RSCI SPIN-code: 7555-8039.



1. Krylov V.V. Surgery for epilepsy. Мoscow: ABV-press; 2019: 408 pp. (in Russ.).

2. Karlov V.A. Epilepsy in children and adult women and men. A guide for doctors. 2nd ed. Мoscow: BINOM; 2019: 896 pp. (in Russ.).

3. Mamatkhanov M.R., Lebedev K.E., Sebelev K.I. Neuroimaging in surgical treatment of drug-resistant epilepsy in children. Pediatric Neurosurgery and Neurology. 2011; 3: 10–7 (in Russ.).

4. Téllez-Zenteno J.F., Hernández Ronquillo L., Moien-Afshari F., Wiebe S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res. 2010; 89 (2-3): 310–8.

5. Blount J.P. Extratemporal resections in pediatric epilepsy surgery – an overview. Epilepsia. 2017; 58 (1): 19–27.

6. Jayakar P., Dunoyer C., Dean P., et al. Epilepsy surgery in patients with normal or nonfocal MRI scans: integrative strategies offer long-term seizure relief. Epilepsia. 2008; 49 (5): 758–64.

7. Widjaja E., Jain P., Demoe L., et al. Seizure outcome of pediatric epilepsy surgery: systematic review and meta-analyses. Neurology. 2020; 94 (7): 311–21.

8. Engel J. Jr. (Ed.) Surgical treatment of the epilepsies. 2nd ed. Raven Press; 1993: 786 pp.

9. Bast T. Outcome after epilepsy surgery in children with MRI-negative non-idiopathic focal epilepsies. Epileptic Disord. 2013; 15 (2): 105–13.

10. Eltze C.M., Chong W.K., Bhate S., et al. Taylor-type focal cortical dysplasia in infants: some MRI lesions almost disappear with maturation of myelination. Epilepsia. 2005; 46 (12): 1988–92.

11. Paolicchi J.M., Jayakar P., Dean P., et al. Predictors of outcome in pediatric epilepsy surgery. Neurology. 2000; 54 (3): 642–7.

12. McGonigal A., Bartolomei F., Régis J., et al. Stereoelectroencephalography in presurgical assessment of MRI- negative epilepsy. Brain. 2007; 130 (12): 3169–83.

13. Wang Z.I., Alexopoulos A.V., Jones S.E., et al. The pathology of magnetic-resonance-imaging-negative epilepsy. Mod Pathol. 2013; 26 (8): 1051–8.

14. Bien C.G., Szinay M., Wagner J., et al. Characteristics and surgical outcomes of patients with refractory magnetic resonance imaging- negative epilepsies. Arch Neurol. 2009; 66 (12): 1491–9.

15. Mohamed I.S., Toffa D.H., Robert M., et al. Utility of magnetic source imaging in nonlesional focal epilepsy: a prospective study. Neurosurg Focus. 2020; 48 (4): E16.

16. Juhász C., John F. Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy. Seizure. 2020; 77: 15–28.

17. Khachatryan V.A., Mamatkhanov M.R., Lebedev K.E. Invasive EEG-monitoring for surgical treatment of epilepsy in children. The Russian Neurosurgical Journal named after prof. A.L. Polenov. 2014; 6 (4): 21–6 (in Russ.).

18. Khachatryan V.A., Mamatkhanov M.R., Shershever A.S. Multifocal resection in therapy of pediatric progredient epilepsy. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2020; 12 (3): 147–57 (in Russ.).

19. Engel J. Jr., McDermott M.P., Wiebe S., et al. Early Randomized Surgical Epilepsy Trial (ERSET) Study Group. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012; 307 (9): 922–30.

20. Braun K.P., Cross J.H. Pediatric epilepsy surgery: the earlier the better. Expert Rev Neurother. 2018; 18 (4): 261–3.

21. Mula M., Zaccara G., Galimberti C.A., et al. Validated outcome of treatment changes according to International League Against Epilepsy criteria in adults with drug-resistant focal epilepsy. Epilepsia. 2019; 60 (6): 1114–23.

22. Kim D.W., Lee S.K., Jung K.Y., et al. Surgical treatment of nonlesional temporal lobe epilepsy. Seizure. 2021; 86: 129–34.

23. Trinka E., Cock H., Hesdorffer D., et al. A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015; 56 (10): 1515–23.

24. Ushanov V.V., Odintsova G.V., Gerasimov A.P., et al. Surgical treatment of epilepsy: subjective readiness of patients. The Russian Neurosurgical Journal named after prof. A.L. Polenov. 2020; 12 (3): 31–6 (in Russ.).

25. Karlov V.A., Burd S.G., Mironov M.B., et al. Epileptological service in current Russia. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2021; 13 (1): 6–20 (in Russ.).


For citations:

Mamatkhanov M.R., Ushanov V.V., Gerasimov A.P., Khachatryan W.A. Surgical treatment of MRI-negative drug resistant epilepsy in children. Epilepsy and paroxysmal conditions. 2022;14(2):195-203. (In Russ.)

Views: 283

ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)