SURGICAL-TREATMENT OF EPILEPSY IN CHILDREN

In carefully selected children, as well as adults, intractable seizure s may be eliminated or greatly reduced by cortical resection or hemisp herectomy. Critical features of surgical candidacy include intractable disabling epilepsy, a localized epileptogenic zone, and a low risk of new postoperative deficits; however, the analysis may be complicated in children. Compared with adults, pediatric patients are especially l ikely to present with poorly localizing electroencephalographic featur es because of their high incidence of extratemporal localization and d evelopmental pathology. Maturation factors may result in unusual epile psy manifestations, for example, infantile spasms and hypsarrhythmia c aused by a focal cortical lesion. The cognitive and psychosocial costs of continued frequent seizures during infancy and childhood must be a ssessed differently from those in adults and may include stagnation of developmental progression. The risk for new postoperative deficits ma y be modified if surgery is performed during stages of active brain ma turation with developmental plasticity. For each individual child, the potential risk/benefit ratio for surgery must be carefully weighed on the basis of results of an extensive preoperative evaluation. Results from pediatric epilepsy surgery series are encouraging, with percenta ges of seizure-Tree patients similar to those in adult series. In some series, delaying surgery for childhood-onset epilepsy into adulthood was associated with greater permanent psychosocial, behavioral, and ed ucational problems. The available data suggest that children should be considered for surgical evaluation at whatever age they present with severe intractable localization-related epilepsy. Complicated cases wa rrant referral to specialized centers with extensive pediatric epileps y surgery experience. (C) 1998 by Elsevier Science Inc. All rights res erved.