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Surgical treatment of epilepsy. Clinical aspects in children
1National Center for Epilepsy, Sandvika, Norway.
Insights
Neurosurgery, like temporal lobectomy, offers significant seizure relief for children with intractable epilepsy. Early surgical consideration is vital due to poor prognoses and potential long-term complications.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Clinical Neurology
Background:
- Intractable epilepsy in children carries a poor prognosis.
- Long-standing seizures can lead to severe sequelae and medication side effects.
- The development of secondary epileptic foci (mirror foci) is a concern.
Purpose of the Study:
- To evaluate the role and timing of neurosurgery in managing pediatric intractable epilepsy.
- To highlight the benefits of early surgical intervention.
- To emphasize the importance of comprehensive evaluation at specialized epilepsy centers.
Main Methods:
- Review of neurosurgical outcomes, focusing on temporal lobectomy.
- Analysis of factors influencing the decision for early surgical intervention.
- Discussion of multidisciplinary team evaluations at epilepsy centers.
Main Results:
- Neurosurgery, particularly temporal lobectomy, provides substantial seizure relief in approximately two-thirds of pediatric cases.
- Early surgical intervention can prevent long-term complications associated with uncontrolled epilepsy.
- Multidisciplinary evaluation aids in optimizing treatment decisions.
Conclusions:
- Neurosurgery should be strongly considered for children with intractable epilepsy due to favorable outcomes and the risks of delayed treatment.
- The optimal age for surgery depends on seizure characteristics, EEG findings, epilepsy progression, and concordant brain pathology.
- Comprehensive evaluation at an epilepsy center is advantageous for patients and families, facilitating informed decisions regarding neurosurgery.
Abstract:
Neurosurgery, mainly temporal lobectomy, has given substantial relief of serious seizure problems in two-thirds of children with intractable epilepsy. Since the prognoses of children with an intractable epilepsy is poor, surgery should be considered. To prevent sequela of a long standing seizure disorder and side effects of antiepileptic medication as well as the development of mirror foci, surgery should be considered at an early age. The age at which surgery should be undertaken depends upon several factors, for instance: the seizure problem, the EEG findings--are they persistently focal and do they fit with the seizures? Is there a malignant development of the epilepsy and little or no chance of remission? And especially, if there is brain pathology in concordance with the clinical findings and EEG signs, neurosurgery should not be postponed. It is of great advantage for children with an intractable epilepsy to be evaluated at an epilepsy center. Both the children and their parents will profit from the evaluation and information gained as well as education by a multiprofessional team. This will optimise the difficult decision process which may lead to neurosurgery.