Present status of surgical intervention for children with intractable seizures
Dewi T Depositario-Cabacar1, James J Riviello, Masanori Takeoka
1Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA. dcabacar@cnmc.org
Insights
Pediatric epilepsy surgery is advancing, with new guidelines for selecting children with severe refractory epilepsy. Early surgical intervention shows significant benefits for selected pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Neuroimaging
Background:
- The Subcommission for Pediatric Epilepsy Surgery was established by the International League Against Epilepsy in 1998.
- Severe refractory epilepsy in children necessitates advanced diagnostic and treatment strategies.
- Functional neuroimaging plays a crucial role in pre-operative evaluation for epilepsy surgery.
Purpose of the Study:
- To discuss recent publications and recommendations concerning pediatric epilepsy surgery.
- To review updates on the identification and selection criteria for pediatric patients with severe refractory epilepsy.
- To summarize advancements in functional neuroimaging techniques for pre-operative evaluation.
Main Methods:
- Review of recent relevant publications in pediatric epilepsy surgery.
- Inclusion of recommendations from the International League Against Epilepsy's Subcommission for Pediatric Epilepsy Surgery.
- Summary and discussion of functional imaging modalities, including positron emission tomography (PET) and single photon emission computed tomography (SPECT).
Main Results:
- Functional imaging modalities like PET and SPECT are beneficial for identifying the epileptogenic zone.
- Newer imaging techniques are under investigation and require further validation.
- Studies demonstrate positive postoperative outcomes associated with early surgical treatment in selected pediatric cases.
Conclusions:
- Early surgical treatment offers significant benefits for carefully selected children with refractory epilepsy.
- Advancements in neuroimaging improve the identification and selection of surgical candidates.
- Continued research and validation of new techniques are essential for optimizing pediatric epilepsy surgery.
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.
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