Present status of surgical intervention for children with intractable seizures

Abstract

We present a discussion of recent relevant publications in pediatric epilepsy surgery. In 1998, the Commission on Neurosurgery of the International League Against Epilepsy formed the Subcommission for Pediatric Epilepsy Surgery. Their proposed recommendations are included here. We also discuss updates on identification and selection of children with severe refractory epilepsy. Functional imaging has advanced in recent years as an important adjunct in identifying the epileptogenic zone during the preoperative evaluation. The newer imaging modalities are summarized. Routine positron emission tomography, positron emission tomography with special tracers, and single photon emission computed tomography have proven to be beneficial. Other newer investigative techniques await validation. A number of studies on postoperative outcomes over the past few years have demonstrated the benefits of early surgical treatment for selected children.

Long‐term outcome of resective epilepsy surgery in Norwegian children

“…In agreement with previous studies, we found the best seizure outcome among the children with temporal lobe resections or hemispherotomies (6,7,10). However, in our cohort, the rate of seizure freedom after temporal resection was not as high as in some adult series (11,12).…”

“…The 11 of the 12 children who were reoperated had cortical dysplasias, either alone or as dual pathology and at follow‐up, nine still had seizures. Thus, in these cases, a radical removal of the seizure‐generating region is a challenging task, in some cases also owing to near approximation to eloquent cortex (4,6,10).…”

Role of SPECT and PET in pediatric epilepsy

“…Epilepsy surgery in children is better tolerated than adults due to the plasticity of immature pediatric brain [4]. The child's brain has a relative high capability to reorganize neurologic function after insult or surgery [7]. This plasticity is important in the recovery of language seen in infants and very young children.…”

“…This functional plasticity also has disadvantages, because frequent recurrent seizures may cause adverse effects on the developing brain, with transient and long lasting disruptions of neural circuitry and permanent memory dysfunction. Therefore, children with severe seizure types may benefit from surgery if performed earlier rather than later [7]. However, despite recent developments in pediatric epilepsy surgery, in most centers, there is still a reluctance and delay of 12 to 15 yr to refer children for surgery [1,7].…”

Response to “A graded system to categorize drug-resistant epilepsy”

“…This financial cost also does not reflect the costs of human suffering, as patients with MFR have a much higher mortality and injury rate and have increased cognitive and psychosocial dysfunction (Sperling, 2004). Despite the current success rate of modern epilepsy surgery, the time lag from developing MFR to a surgical referral is still typically 12–15 years (Berg, 2004; Depositario‐Cabacar et al., 2008). For these reasons, we urge that any grading system for MFR must not include rigid guidelines for treatment, but defer to clinical judgment and the best interests of the patient.…”