Localization of epileptic foci in children

Electroencephalographic and neuro-imaging data were correlated with the lobe of cortical resective surgery among 48 patients age 16 years or less with medically intractable partial seizures. Decisions about surgery were determined by clinical judgement and therefore our results reflect the weight of these factors in clinical practise. Neuro-imaging disclosed a lesion over the operated lobe in 32 patients (67%). Multiple EEGs demonstrated a most active spike focus over the operated lobe in 32 patients (67%). Although only 34 patients had a recorded seizure, this clearly arose over the operated lobe in 23 (68% of the 34 patients; 48% of series). Persistent focal delta activity appeared in 20 of the 48 patients (42%). No instance was encountered in which false lateralization of regional or focal interictal EEG spikes or delta when normal apiculate phenomena were excluded. Thus, the scalp EEG remains a valuable guide to epileptogenesis, even among young patients, and should continue to play a major role in determining the region of cortical resection. Effectiveness of cortical resection for seizure control was clearly better among patients with a single major lesion and among those with normal intelligence.