Trends in Pediatric Epilepsy Surgery

Abstract

Epilepsy surgery has become an accepted treatment for drug resistant epilepsy in infants and children. It has gained ground in India over the last decade. Certain epilepsy surgically remediable syndromes have been delineated and should be offered surgery earlier rather than later, especially if cognitive/behavioral development is being compromised. Advances in imaging, particularly in MRI has helped identify surgical candidates. Pre-surgical evaluation includes clinical assessment, structural and functional imaging, inter-ictal EEG, simultaneous video -EEG, with analysis of seizure semiology and ictal EEG and other optional investigations like neuropsychology and other newer imaging techniques. If data are concordant resective surgery is offered, keeping in mind preservation of eloquent cortical areas subserving motor, language and visual functions. In case of discordant data or non-lesional MRI, invasive EEG maybe useful using a two-stage approach. With multi-focal / generalized disease, palliative surgery like corpus callosotomy and vagal nerve stimulation maybe useful. A good outcome is seen in about 2/3rd of patients undergoing resective surgery with a low morbidity and mortality. This review outlines important learning aspects of pediatric epilepsy surgery for the general pediatrician.

Development of a Pediatric Epilepsy Program: Analysis of Early Multidimensional Outcomes

“…[4][5][6] Of newly diagnosed patients with epilepsy, nearly half (i.e., 47%) will attain seizure freedom with just one AED. 7 Another 13% of patients are estimated to achieve seizure freedom with the addition of a second medication. Beyond this, an effect of diminishing returns is established, with only 4% benefiting from the addition of a third agent.…”

Endoscopic-Assisted (Through a Mini Craniotomy) Corpus Callosotomy Combined With Anterior, Hippocampal, and Posterior Commissurotomy in Lennox-Gastaut Syndrome

“…Currently, CC is being increasingly replaced with vagal nerve stimulation, [21][22][23][24][25][26][27] mostly because the former is considered as a palliative "destructive" surgery. More recent studies have demonstrated that after CC, in some patients, there is a better localization of the epileptogenic focus.…”

Editorial: Advances in Neurology

“…I have outlined the present status of epilepsy surgery in children [6]. We at the Hinduja Hospital in Mumbai have a small experience since the last several years in evaluation and surgical treatment of children with refractory epilepsies.…”