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Surgical Approaches to Treating Epilepsy in Children

  • PEDIATRIC NEUROLOGY (HS SINGER, SECTION EDITOR)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Surgery for refractory epilepsy in appropriately selected children is effective. The key factors influencing a good outcome are careful selection of candidates, early referral to pediatric epilepsy surgical unit, underlying neuropathology and the completeness of surgical resection of the seizure focus. Although the primary aim of a surgery is seizure freedom, benefits are also seen in cognitive development. Early prompt referral is therefore desired to optimise outcome. Focal resections involving the temporal and frontal lobes are the common resective procedures in children, with cortical malformations the most common underlying pathology. Hemispherectomy or multilobar procedures are more commonly performed in children younger than four years. Seizure free rates reach 60–80 %. The availability of newer techniques for presurgical evaluation, along with invasive intracranial electroencephalographic (EEG) recording, has facilitated surgical consideration. Resective surgery may also be beneficial for children who may appear to have bilateral or generalised clinical or EEG features associated with focal lesions on MRI. Vagal Nerve Stimulation (VNS) and corpus callosotomy are employed for selected candidates not suitable for resective surgery with good results.

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Disclosure

Dr. Cross holds an endowed chair through the University College, London. She has sat on advisory panels for Eisai and Viropharma, for which remuneration has been paid to her department. She has received money for her department from an educational grant from UCB and Eisai for a clinical training fellowship in epilepsy. She currently holds grants for research as co-investigator from Action Medical Research, Epilepsy Research UK, and the Great Ormond Street Hospital Children’s Charity. She worked as clinical advisor to the update of the NICE guidelines on the diagnosis and management of epilepsy (2009–2012), for which remuneration was made to her department.

Dr. Jadhav reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Great Ormond Street Hospital for Children NHS Trust, London, UK

    Trupti Jadhav MB BS, DCH, DNB & J. Helen Cross MB ChB, PhD, FRCP, FRCPCH

  2. UCL-Institute of Child Health, London, UK

    J. Helen Cross MB ChB, PhD, FRCP, FRCPCH

  3. Young Epilepsy, Lingfield, UK

    J. Helen Cross MB ChB, PhD, FRCP, FRCPCH

  4. Neurosciences Unit, The Prince of Wales’s Chair of Childhood Epilepsy, 4/5 Long Yard, London, WC1N 3LU, UK

    J. Helen Cross MB ChB, PhD, FRCP, FRCPCH

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  1. Trupti Jadhav MB BS, DCH, DNB
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  2. J. Helen Cross MB ChB, PhD, FRCP, FRCPCH
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Correspondence to J. Helen Cross MB ChB, PhD, FRCP, FRCPCH.

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Jadhav, T., Cross, J.H. Surgical Approaches to Treating Epilepsy in Children. Curr Treat Options Neurol 14, 620–629 (2012). https://doi.org/10.1007/s11940-012-0203-8

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  • DOI: https://doi.org/10.1007/s11940-012-0203-8

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