EPILEPSY SURGERY IN CHILDREN

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.