Surgical Indication for Refractory Childhood Epilepsy

Abstract

Summary: Recent progress in surgical intervention for mcdically refractory epilepsy has hclped to shed light on more complex epileptogcnic problems in children and infants. Surgical treatment increasingly is being used in pediatric patients, but the indications for surgery in this age group have not been well dcfincd. The developing child with a seizure disordcr has sevcral problems that are dilferent from adults, such as neural plasticity, dclctcrious effccts of seizures on developmental status, and spontaneous resolution of cpilcpsy. The critical age for irreversiblc brain dysfunction and the timing of surgery arc the main issues for thc treatment of children. Thus, carlier surgical intervention is generally recommended to prevent further detrimental seizure effccts, but we still do not know the optimal age. Until the establishment of guidelines for pediatric cpilcpsy surgery, surgical indications should be determined by the prognosis and the presence of a rescctahlc cpilcptogcnic rocus, which in turn are bascd on the localization of the epileptic focus, seizure frequency, scvcrity, and cognitive function of each case, rather than just the patient's age.

Present status of surgical intervention for children with intractable seizures

“…Insults occurring during early infancy will leave less serious neurologic complications than if they occurred during adulthood or older childhood. [12]. This plasticity is important in the language recovery seen in infants and very young children.…”

Spatial attention can transfer to the contralateral hemisphere in neonatal stroke patients: a case report following hemispherectomy

“…His recitation and writing were adequate, indicating that no hemispatial neglect had occurred. Because brain plasticity is greater in early childhood (Chiricozzi et al, 2005;Oguni et al, 2000), it is possible that under some extreme stress situation the spatial function transfers to the contralateral (left) side. Therefore, based on our observation, hemispherectomy has been a safe procedure.…”

Neuropsychological Deficits in Childhood Epilepsy Syndromes

“…Lower age of onset has been associated with lower performance IQ, and patients with later onset performed better when copying the Rey Complex Figure (Jambaque et al 2007). Persistent seizures in childhood might slow down the rate of cognitive and psychological development (Oguni et al 2000). Children with longer duration of epilepsy have been shown to have lower IQs than children with a shorter seizure history (Robinson et al 2000), and long-term effects of intractable seizures may be more deleterious for children than adults (Bjornaes et al 2001).…”