To examine the long-term seizure and functional outcome in children who had occipital or occipital-plus resections.

Although seizure outcomes in children with posterior cortex epilepsy surgery has been reported, data on functional outcome is limited.

We reviewed 103 children who underwent occipital or occipital-plus (occipito-temporal, occipito-parietal, temporo-parieto-occipital) resections between 2000 and 2020. Fifty-one families completed a questionnaire to assess the functional status in speech, reading ability, and school placement.

Of the 103 patients, 61 (60%) had a favorable outcome (45 Engel I, 16 Engel II) and 41 (39%) had an unfavorable seizure outcome (26 Engel III, 15 Engel IV). On multivariate analysis the following predicted poor seizure outcome: daily seizures, multi-lobar lesions with contralateral hemispheric involvement on MRI, occipitoparietal or temporo-parieto-occipital resections, non-tumor pathology, and acute post-operative seizures.  Of 51 patients who completed the questionnaire, speech was age appropriate in 45%; 24% had mild delay, 12% had moderate delay, and 20% had minimal words or were nonverbal. In school aged children, reading was age appropriate in 31%; 35% were reading below their grade level, 27% were able to recognize alphabet/numbers or a few words, and 7% were unable to read. 80% attended regular school with two-third requiring assistive services, and 20% were in a special-education school. Older age at onset of seizures and normal development or language prior to surgery were significantly associated with favorable outcome in all three functional measures. Interictal and ictal changes unilateral to surgery was associated with a favorable outcome for both speech and reading. The side of surgery had no impact on outcome.

More than two-third of children with occipital or occipital-plus resection had reading difficulties at follow up. Early age at seizure onset, pre-existing developmental delay, and EEG abnormalities in both hemispheres are associated with poor functional outcome in speech and reading.