- Summary:Purpose: Partial seizures in early postnatal life may be catastrophic and associated with poor long-term outcome. Epilepsy surgery can alleviate partial seizures in older children and adults, but there is little experience with surgical therapy in infancy apart from hemispheric epilepsy syndromes.Methods: We analyzed the results of cortical resection to treat medically refractory partial epilepsy in 31 children (16 boys, 15 girls) aged <3 years (mean, 18.3 months). Subjects were included only if seizure relief was the primary indication for surgery.Results: Follow-up of at least 1 year (mean, 4.6 years) in 26 patients revealed that 16 were seizure-free, 4 had >90% seizure reduction, and 6 had <90% reduction. There was no significant difference in seizure outcome between hemispherectomy/ multilobar resections and lobar resections or temporal versus extratemporal resection. Seizure outcome was independent of the amount of cortex removed in nonlesional patients. Only the presence of a discrete lesion on preoperative neuroimaging correlated with a favorable outcome. Family perceptions of accelerated development in seizure-free patients were not confirmed on developmental assessment.Conclusions: We conclude that cortical resection often benefits very young children with catastrophic partial seizures, but does not guarantee enhanced neurological development. The location and extent of the excised cortex may not be critical as long as the entire epileptogenic region and tesion are removed.

Summary:Purpose: Children with tuberous sclerosis complex (TSC) benefit from excisional surgery if seizures can be localized to a single tuber. We evaluated the role of noninvasive studies to localize the epileptogenic tuberhegion (ET/R) and the outcome of focal resection.Methods: We identified 21 children with TSC, ages 3 months to 15 years (mean 4.8 years). All had video-(electroencephalogram) EEG and magnetic resonance imaging (MRI) scans, and 18 also had ictal single photon emission-computed tomography (SPECT) studies. An ET/R was localized in 17 patients. Thirteen patients underwent resection guided by intraoperative electrocorticography (n = 7) or subdural monitoring (n = 6).Results: Interictal EEG revealed a principal spike focus (PSF) that corresponded to the ET/R in 14 children. In seven, PSFs occurred in rhythmic runs. PSFs were not observed remote from the ET/R. Focal polymorphic slowing and attenuation occurred in the region of the PSF in 1 I patients. Sixteen patients demonstrated an ictal focus corresponding to the ET/R. Ictal SPECT revealed focal hyperperfusion correlating with the ET/R in 10 patients. Although the MRIs in all children revealed multiple tubers, the E T R corresponded to a large discrete tuber in 8 patients and a calcified tuber in 13 patients. Patchy calcified tubers were also seen elsewhere in six patients. At a mean follow-up of 26 months, 9 of the 13 children who underwent surgery were seizure-free, one had greater than 75% reduction in seizures, two were unchanged, and one was lost to follow-up. New seizures developed in one child from a contralateral tuber.Conclusions: Surgical resection of an ET/R alleviates seizures in most children with TSC and intractable epilepsy. The scalp EEG and MRI help define the ET/R and improve case selection when ictal SPECT is nonlocalizing.

Lamotrigine was effective for the adjunctive treatment of partial seizures in children and demonstrated an acceptable safety profile.

Pharmacokinetic and pharmacodynamic data are crucial in determining dosage regimens for newly developed drugs. While sufficient information to ensure safe and effective therapy is usually available for the general population, these data may rarely be available for patient subpopulations. In reviewing the paediatric data, there is an obvious dearth of pharmacokinetic and pharmacodynamic information for most therapeutic agents in newborns, infants and children. The information that is often available for this population consists largely of anecdotal and case reports or studies with low patient enrolments. This type of data is frequently of poor scientific merit and inappropriate for the extrapolation of meaningful information for the basis of dosage determinations. Unfortunately, this situation often leads to rudimentary, experiential pharmacotherapy in neonates and children which may result in incomplete therapeutic responses or even devastating outcomes. Recognising this danger, drug selection in children is often based solely on the availability of data. One agent may be selected over an alternative simply as a result of more paediatric experience and available pharmacokinetic information. Alternative agents may actually be more effective and less toxic than the drug selected, but lack sufficient paediatric documentation. This article discusses issues related to the paucity ofpharmacokinetic and pharmacodynamic data in newborns and children and, along with the review of Kauffman & Kearns (1992), elsewhere in this issue, proposes means of overcoming the obstacles of performing research in children.