Epilepsy surgery in children

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epileptology

Background:

• Focal epilepsy affects 60% of epilepsy patients, with 15% experiencing drug-resistant seizures.
• A significant portion of these patients are children, making them candidates for surgical intervention.
• Intractable seizures in children can severely impact quality of life and cognitive development.

Purpose of the Study:

• To review the role and outcomes of epilepsy surgery in children with intractable focal epilepsy.
• To emphasize the importance of early surgical evaluation and intervention.
• To outline different surgical approaches and palliative procedures for pediatric epilepsy.

Main Methods:

• Review of multimodality presurgical evaluation techniques for identifying the epileptogenic zone.
• Analysis of outcomes for resective and disconnection surgeries in carefully selected pediatric cases.
• Discussion of palliative procedures like corpus callosotomy and vagal nerve stimulation.

Main Results:

• Epilepsy surgery can achieve seizure freedom or >90% reduction in approximately two-thirds of carefully selected children.
• High concordance among presurgical investigations is crucial for accurate localization of the epileptogenic zone.
• Early surgery is associated with improved quality of life and better cognitive and developmental outcomes.

Conclusions:

• Surgically remediable epilepsies in children, including temporal lobe, extratemporal, hemispheric, and gelastic epilepsies, should be identified early.
• Surgery should be considered a primary treatment option for eligible children, not a last resort.
• Palliative options exist for children unsuitable for resective surgery, with deep brain stimulation under evaluation.