OMPLEX partial seizures (CPS) are not infrequent in children. The majority of adults with CPS had the onset of their epilepsy before the age of 20 years; 1 and among children with epilepsy, the seizure type is complex partial in approximately 13% to 25% of patients. 2 " 4 CPS are often intractable to medication, leading to thoughts of possible surgery; and in fact, many of these patients do have a single resectable epileptogenic focus. This review will address some considerations in the identification of pediatric epilepsy surgery candidates and the timing of operation.
DEFINITIONSThe hallmark of partial seizures in children and adults is focal epileptiform discharges localized to a portion of one cerebral hemisphere. With the current classification system, partial seizures are further divided into "simple" or "complex" types: complex partial seizures include impairment of consciousness, and simple partial seizures do not. 5 The impairment of consciousness during CPS may occur at onset of the episode or after an initial simple partial seizure with preserved consciousness. When the preceding simple partial seizure is sensory, it is sometimes called an aura. With this classification system, "complex" does not mean "complicated," and this variance from the collo- Neurophysiology (E.W., H.L.) and Section of Pediatric Neurology (E.W.), The Cleveland Clinic Foundation.
Section of Epilepsy and Clinical