Can we simplify preoperative testing of children?

This retrospective study concerns 28 patients, evaluated for their drug-res istant partial epilepsy before the age of 16 years and operated on before t he age of 18 years, without invasive presurgical evaluation and with a mini mum follow-up of two years. They represent 59.6% of our 'paediatric' popula tion (47 patients) operated on from 1990 to 1994 at Grenoble Hospital. Seiz ures were recorded on scalp EEG in 18/28 (64%), while ictal clinical sympto matology, corroborated by interictal EEG and anatomical dam, were judged su fficient to propose a surgical treatment lit the remaining 10 (36%). lit 17 out of the 28 patients (60.7%), the anatomo-electro-clinical caracteristic s suggested a temporal lobe origin of seizures. Fourteen of them (82%) ale completely seizure free after surgery (Engel's Class IA). Good results were also obtained among the 5 patients suffering front an extratemporal unilob ar epilepsy, i.e. 80% Class IA. Conversely, only 33% of the 6 patients with a multilobar epilepsy are completely seizure free. Children suffering from a severe drug-resistant partial epilepsy can be ope rated on with excellent results without previous invasive procedures. This need a rigorous selection among children candidates to epilepsy surgery, ba sed on individual anatomo-electro-clinical correlates.