Abstract
Twenty-five percent of children with epilepsy continue to seize despite the best medical
management and may be defined as medically refractory. Many children with medically
refractory localization-related epilepsy, i.e. seizures which originate in a particular
area of the brain and secondarily spread to involve other brain regions, may benefit
from a variety of surgical treatments including hemispherectomy, corpus callosotomy,
focal cortical resection of the temporal lobe, focal cortical resection of extratemporal
regions of the brain, and multiple subpial resections. A successful outcome from epilepsy
surgery is generally defined as a seizure-free state with no imposition of neurologic
deficit. In order to achieve these twin goals two criteria must be fulfilled. First,
precise localization of the epileptogenic zone in the brain is necessary. The epileptogenic
zone may be defined as the region of epileptogenic cerebral cortex whose removal will
result in a seizure-free state. Second, one must determine the anatomic localization
of eloquent cortex in the brain in order to spare these areas during any planned cortical
excision of epileptogenic cortex. Several diagnostic measures may be used to achieve
a successful surgical outcome. A clinical history to ascertain the earliest symptom
in the clinical progression of the seizure (semiology) is imperative as is ictal and
interictal scalp EEG, neuropsychological testing, magnetic resonance imaging, positron
emission tomography, single photon emission computerized tomography, and interictal
magnetoencephalography. In the typical child undergoing evaluation for epilepsy surgery,
if the clinical, neuropsychological, EEG, and radiological data are all concordant
and point to the same area of epileptogenicity in the brain, cortical excision of
the suspected epileptogenic zone is undertaken. However, if the data are discordant,
and/or the epileptogenic zone resides wholly or in part within eloquent cortex, invasive
intracranial monitoring from depth and/or subdural electrodes during a seizure is
required to map out the areas of epileptogenicity in the brain. The assessment of
potential risks and benefits for this type of epilepsy surgery in children involves
complex age-related issues, including the possible impact of uncontrolled seizures,
medication, or surgery on learning and development.
Keywords
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Article info
Publication history
Accepted:
February 27,
2001
Received in revised form:
February 27,
2001
Received:
June 14,
2000
Identification
Copyright
© 2001 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
