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Pediatric Epilepsy Surgery

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Surgical Treatment of Epilepsies

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Abstract

Epilepsy is one of the most frequent neurological diseases in the pediatric age group, particularly in the first years of life. Cohort studies have shown that 50–70% of children achieve long-term seizure freedom under anticonvulsive drug treatment, while 20–25% present persistent seizures, and 10–15% fulfill the criteria of pharmacoresistance. Advances in MR imaging facilitating detection of cortical malformations as the most important structural abnormalities in the young age have promoted pediatric epilepsy surgery with increasing numbers of surgical, and particularly, extratemporal, multilobar, and hemispheric procedures. Due to the ongoing brain development and myelinization, however, interpretation of MR images is rendered difficult in the first years of life, and repeat MRI studies in negative cases are required. In addition, clinical and electrophysiological presurgical assessment is impeded in early life by unspecific seizure semiology and diffuse or bilateral EEG patterns. In addition to the seizure burden, there is a noticeable disparity in cognitive development between children with epilepsy and their healthy peers. Epilepsy onset in the first years of life, with poor response to anti-seizure drugs and frequent epileptic seizures, will eventually result in developmental stagnation or even regression. Surgical treatment has been shown to provide seizure-free outcome in 60–80% of children with intralobar resections, while results of multilobar procedures are less favorable with long-term seizure control rates of 40–60% and a significant percentage of patients requiring reoperation. Additional to seizure alleviation, epilepsy surgery in early life has the potential to successfully address the developmental delay. With epilepsy duration constituting the only modifiable predictor for seizure and developmental outcome, there is a general consensus to offer surgery as soon as intractability of epilepsy is ascertained, including in the first years of life. Given the obvious benefits of plasticity in overcoming anticipated functional deficits, early intervention and more radical and thus complete lesion resection is justified.

The true measure of any society can be found in how it treats its most vulnerable members.

Mahatma Gandhi

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    Josef Zentner

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Zentner, J. (2020). Pediatric Epilepsy Surgery. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_11

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