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Updated: Aug 17, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Surgically amenable epilepsies in children and adolescents: clinical, imaging, electrophysiological, and
Vera C Terra-Bustamante1, Regina M F Fernandes, Luciana M Inuzuka
1Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Campus Universitário, Brazil.
Insights
Pediatric epilepsy surgery offers favorable long-term seizure control, comparable to adults. Early surgical consideration is recommended for children with medically intractable epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Medically intractable epilepsy affects many children, often with daily seizures and poor response to medication.
- Pediatric epilepsy frequently presents with neurological abnormalities and symptomatic causes.
- Previous studies indicate comparable long-term seizure control in pediatric and adult epilepsy surgery patients.
Purpose of the Study:
- To report the outcomes of the Ribeirão Preto Epilepsy Surgery Program in pediatric epilepsy surgery.
- To evaluate the efficacy of epilepsy surgery in children with medically intractable epilepsy.
- To compare seizure control in pediatric epilepsy surgery patients with existing literature.
Main Methods:
- Analysis of 107 pediatric patients with medically intractable epilepsy who underwent surgery between 1994 and 2002.
- Data collected prospectively included age at surgery, seizure type, pathological findings, and seizure outcome.
- Evaluation of 115 operations, with outcomes assessed using the Engel classification system.
Main Results:
- Overall, 67.2% of patients achieved seizure control (Engel classes I and II).
- Excluding callosotomies, seizure control improved to 75.0%.
- Common etiologies included cortical developmental abnormalities, tumors, and mesial temporal sclerosis.
Conclusions:
- Epilepsy surgery provides similar long-term seizure control in children as in adults.
- Pediatric epilepsies are often extratemporal, yet surgery remains effective.
- Epilepsy surgery should be considered early in children once intractability is established.
Background And Purpose:
A large number of patients with epilepsy in the pediatric population have medically intractable epilepsy. In this age group seizures are usually daily or weekly, and response to antiepileptic therapy is poor, especially for those with neurological abnormalities and symptomatic epilepsies. However, several authors have already demonstrated similarly favorable long-term post-surgical seizure control when comparing pediatric and adult populations. In this article we aim to report the experience of the Ribeirão Preto Epilepsy Surgery Program in pediatric epilepsy surgery.
Patients And Methods:
We analyzed 107 patients with medically intractable epilepsy operated on between July 1994 and December 2002, considering age at surgery, seizure type, pathological findings, and seizure outcome. All data were prospectively collected according to protocols previously approved by the institution ethics committee.
Results:
We analyzed a total of 115 operations performed in 107 patients. There was no difference in sex distribution. Complex partial seizures occurred in 31.4% of the patients, followed by tonic seizures (25.9%), focal motor seizures (15.4%), and infantile spasms (13.3%). The most common etiologies were cortical developmental abnormalities (25.2%), tumors (16.8%), mesial temporal sclerosis (15.9%), Rasmussen syndrome (6.5%), and tuberous sclerosis (6.5%). Overall post-surgical seizure outcome showed 67.2% of the patients within Engel classes I and II, reaching 75.0% when patients with callosotomies were excluded.
Conclusions:
Post-surgical seizure control in the pediatric population is similar to that in adult patients, despite the fact that epilepsies in this age group are more frequently of extratemporal origin, suggesting that surgery should be considered in children as soon as intractability is determined.
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