Children in whom surgery is considered should have a reasonable expectation of seizure elimination or substantially fewer disabling seizures, translating into improved quality of life and perhaps development. There should be minimal risk of losing neurologic function. The definition of intractable is not necessarily the same for all patients. In practical terms, this may be a failure to respond to three well-selected AEDs, used in isolation or in any combination. Because the frequency of seizures in children is often high, this determination need not take years and, often, can be established within a year of onset of the epilepsy. Children with complete resections of focal structural lesions, identified by MRI, fare best, with seizure-free rates as high as 90%. Many of these lesions are congenital slow-growing tumors or cerebral dysgenesis. Mesial temporal sclerosis (a common indication in adult epilepsy surgery) is infrequent in children and adolescents. Without a clear MRI focus, complete long-term seizure freedom is achieved in less than half of patients.
The three main types of epilepsy surgery include:
- temporal or partial temporal lobectomy/lesionectomy - successful in many. The percentage of cure or signifcant seizure reduction varies with different criteria/methods used. [Sotero: 2001]
- corpus callosotomy - used most often for drop attacks or generalized tonic-clonic seizures
- hemispherectomy - more risks than with other surgeries, but sometimes remarkably successful. Loss of function will occur on side of body opposite the removed hemisphere
Steinbok P, Gan PY, Connolly MB, Carmant L, Barry Sinclair D, Rutka J, Griebel R, Aronyk K, Hader W, Ventureyra E, Atkinson
Epilepsy surgery in the first 3 years of life: A Canadian survey.
Epilepsia. 2009;. PubMed abstract
Benifla M, Rutka JT, Otsubo H, Lamberti-Pasculli M, Elliott I, Sell E, RamachandranNair R, Ochi A, Weiss SK, Snead OC 3rd,
Long-term seizure and social outcomes following temporal lobe surgery for intractable epilepsy during childhood.
Epilepsy Res. 2008;82(2-3):133-8. PubMed abstract
|Compiled and edited by:||Lynne M Kerr, MD, PhD - 6/2011|
Sotero de Menezes MA, Connolly M, Bolanos A, Madsen J, Black PM, Riviello JJ Jr.
Temporal lobectomy in early childhood: the need for long-term follow-up.
J Child Neurol. 2001;16(8):585-90. PubMed abstract