[Paediatric epilepsy surgery; the earlier, the better].

Area of Science:

• Neurology
• Neurosurgery
• Paediatric Medicine

Background:

• Refractory epilepsy in children often necessitates advanced treatment strategies.
• Physician experience has long suggested surgical superiority for select cases.
• Lack of equipoise and trial design raise ethical considerations regarding delayed surgical intervention.

Purpose of the Study:

• To present findings from the first randomized trial on paediatric epilepsy surgery.
• To compare the efficacy of surgical treatment versus continued drug management.
• To evaluate factors influencing surgical outcomes in children.

Main Methods:

• Randomized controlled trial comparing immediate surgery versus delayed surgery (after one year).
• Inclusion of well-selected paediatric candidates with refractory epilepsy.
• Assessment of seizure control and cognitive outcomes post-intervention.

Main Results:

• Surgical treatment demonstrated superior efficacy compared to ongoing drug treatment in well-selected candidates.
• Shorter epilepsy duration correlated with better cognitive and seizure outcomes post-surgery.
• High seizure-freedom rates observed for specific pathologies with low surgical risks.

Conclusions:

• Paediatric epilepsy surgery is a highly successful treatment for refractory epilepsy in appropriate candidates.
• Early presurgical evaluation is crucial for children with focal lesional epilepsy.
• Surgical benefits, including improved outcomes and low risks, often outweigh potential risks, especially for lesions outside eloquent brain areas.