Cortical resections in children.

Among the 348 patients with a medically intractable epilepsy investigated t o define whether surgical treatment could be considered, 47 were children. Only 17 patients operated on by cortectomy and having a follow-lip post-ope rative period of at least 2 years were selected. Twelve cases had a symptomatic par-tial epilepsy and 5 cryptogenic one. Som e explorations were more suitable for young patients. MRI, under general an aesthesia if necessary, was repeated in two situations. in the best state w ithout seizures, and in the worst state with many seizures or during status epilepticus. Indeed transitory abnormalities in connection with possible o edema in the epileptic focus can be observed after seizures and status epil epticus. Invasive electrophysiological investigations were performed little as possible in childhood, although such explorations were necessary in 9 p atients. Only 52% of the children were explored by an invasive method where as the percentage was 75% for adults. Stereotactically implanted depth elec trodes (stereo EEG) were used in 7 cases and sub-dural grids in 2 cases. Cr iteria to define the mapping of the resection were similar in children and adults. Nevertheless, functional data from electrophysiological, regional c erebral blood flow and metabolic explorations were considered as much as mo rphological patterns. Fifty-nine per cent of the population is seizure-free after a follow-up period of at least 2 years (2-10 years) (IA Engel's clas sification): 6/9 cases of temporal lobe epilepsy and 4/7 cases of frontal l obe epilepsy.