Multiple subpial transection in Landau-Kleffner syndrome

We have considered multiple subpial transection (MST! as a treatment option for Landau-Kleffner syndrome (LKS) for the past 6 years. The effect of thi s technique on language and cognitive ability, behaviour, seizures, and EEG abnormalities is analysed here. Five children (4 males, 1 female; aged 5.5 to 10 years) underwent MST with sufficiently detailed pre- and postoperati ve data for analysis. Behaviour and seizure frequency improved dramatically after surgery in all children. Improvement in language also occurred in al l children, although none improved to an age-appropriate level. All dye had electrical status epilepticus in sleep (ESES) before surgery, which was el iminated by the procedure. One child has had an extension of his MST due to the recurrence of ESES and accompanying clinical deterioration with good e ffect. An attempt is made to set the effect of MST against the natural hist ory of the condition. MST is an important treatment modality in LKS, althou gh the timing of this intervention and its effect on final language outcome remains to be defined.