Surgery for intractable seizures in infancy and early childhood

Epilepsy surgery is becoming an increasingly used therapy for infants and young children with severe, medically intractable seizures. As in older children and adults, the presurgical evaluations of possible candidates typically consist of a detailed history, neurologic and neuropsychologic examination, and anatomic and functional neuroimaging. The "gold standard" test, however, is the recording of ictal events using simultaneous EEG and video monitoring. While temporal lobe resection is the most commonly performed surgery in older children and adults, nontemporal lobe resections, corpus callosotomies, and hemispherectomies are more commonly performed in younger children. Antiepileptic drugs remain the mainstay of treatment of children with epilepsy. However, the clinician should consider surgery early in the course of the catastrophic seizure disorders of childhood: infantile spasms, Sturge-Weber syndrome, and Rasmussen's encephalitis.