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Medical intractability in children evaluated for epilepsy surgery
J T Gilman1, M Duchowny, P Jayakar
1Division of Clinical Pharmacology, Miami Children's Hospital, FL 33155-3098.
Neurology
|July 1, 1994
Summary
Therapeutic reevaluation is crucial for children with intractable epilepsy before surgery. Correcting medication errors rarely helps, but high-dose carbamazepine may benefit those with structural lesions.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Medically intractable epilepsy in children often necessitates surgical evaluation.
- Assessing prior therapeutic interventions is vital before considering epilepsy surgery.
Purpose of the Study:
- To evaluate the efficacy of therapeutic reevaluation and additional pharmacotherapy in children with intractable epilepsy referred for surgery.
- To determine the impact of correcting antiepileptic drug (AED) treatment omissions.
Main Methods:
- Retrospective analysis of 21 children with medically intractable epilepsy referred for epilepsy surgery.
- Assessment of outcomes after correcting AED treatment omissions and exploring additional pharmacotherapy.
Main Results:
- Correcting AED omissions was ineffective in 90% of children.
- Two children (10%) with structural lesions achieved seizure control with high-dose carbamazepine monotherapy.
Conclusions:
- Therapeutic reevaluation should be performed in all children with medically intractable epilepsy before epilepsy surgery.
- While correcting omissions is generally ineffective, specific pharmacotherapy may benefit select patients with structural lesions.