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Epilepsy surgery in children
1Seizure Unit, Miami Children's Hospital, Florida, USA.
Insights
Pediatric epilepsy surgery is increasingly accepted for treating chronic seizures in children. Advances in diagnosis and surgical techniques offer effective outcomes with low morbidity, though long-term effects require further study.
Area of Science:
- Pediatric Neurology
- Neurosurgery
Background:
- Chronic epilepsy in children is a significant health concern.
- Epilepsy surgery is emerging as a vital treatment option for pediatric patients.
- Understanding the natural history of childhood seizures is crucial for treatment efficacy.
Purpose of the Study:
- To review recent advancements in pediatric epilepsy surgery.
- To correlate surgical outcomes with the natural history of childhood seizures.
- To highlight improvements in candidate selection and surgical techniques.
Main Methods:
- Review of current literature on pediatric epilepsy surgery.
- Analysis of diagnostic tools like ictal single photon emission computed tomography (SPECT) and subdural electroencephalogram (EEG) recording.
- Evaluation of outcomes for excisional and commissural procedures.
Main Results:
- Improved candidate selection due to better understanding of medically resistant seizures and early hippocampal sclerosis.
- Increased importance of ictal SPECT and subdural EEG for localization in extratemporal epilepsy.
- Seizure control outcomes in children are comparable to adults, regardless of age.
Conclusions:
- Pediatric epilepsy surgery is an effective intervention with low morbidity.
- Surgical therapy offers favorable seizure control for children with chronic epilepsy.
- Further research into the long-term effects of pediatric epilepsy surgery is warranted.
Abstract:
The practice of operating on children with chronic epilepsy is rapidly gaining acceptance as an important therapeutic modality. This review summarizes some of the recent advances in pediatric epilepsy surgery in relation to the natural history of chronic childhood seizures, surgical treatment, and outcome. Candidate selection has been greatly facilitated by new information bearing on the natural history of medically resistant seizures and the greater than expected incidence of early hippocampal sclerosis. Because the majority of children suffer from extratemporal epilepsy, ictal single photon emission computed tomography and subdural electroencephalogram recording are becoming increasingly important for both seizure and functional localization in the child, and have been shown to be well tolerated, even in very young patients. Furthermore, the outcome of both excisional and commissural procedures in early life with respect to seizure control is similar to that reported for adults, irrespective of age. More information about the long-term effects of epilepsy surgery in children is urgently needed, but the available data confirms surgical therapy as an effective intervention with low morbidity.