Resection of the hippocampus ipsilateral to the verbal memory–dominant hemisphere frequently results in severe memory deficits. In adults with epilepsy, multiple hippocampal transections (MHTs) have resulted in excellent seizure outcome with preservation of verbal memory. The authors report the first detailed case of a child undergoing MHTs for mesial temporal lobe epilepsy. A 13-year-old right-handed boy had intractable seizures characterized by epigastric discomfort evolving to unresponsiveness and chewing automatisms, lasting 1 minute and occurring 2–3 times weekly, sometimes ending in a generalized tonic-clonic seizure. He had no seizure risk factors and nonfocal examination results. Interictal electroencephalography (EEG) showed frequent left temporal epileptiform discharges (maximum FT9) and intermittent slowing. Video EEG, FDG-PET, and 1.5-T MRI were nonlocalizing. Neuropsychological evaluation suggested left temporal lobe dysfunction. A stereo-EEG investigation using 8 electrodes localized the seizure onset zone to the anterior mesial temporal region, immediately involving the hippocampus. The temporal pole and amygdala were resected en bloc with 3 MHTs. Comparison of neuropsychological tests 4 months before and 6 months after the surgery showed a significant decline only in confrontational naming and no significant change in verbal memory. Six and a half years later, the patient remains seizure free with no antiepileptic drugs. In children with established hemispheric dominance suffering from mesial temporal lobe epilepsy, MHTs may be an option.

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Catastrophic epilepsy in infants, often due to extensive cortical dysplasia, has devastating consequences with respect to brain development. Conventional lobar, multilobar, or hemispheric resection in these infants is challenging, carrying an increased operative risk compared with that in older children. Removing a larger tissue volume versus removing or disconnecting the epileptogenic region does not always guarantee better seizure outcome. The authors describe 2 infants with catastrophic epilepsy who benefited from individually tailored disconnections based on a hypothesized epileptogenic zone following intensive presurgical evaluation. Two infants with catastrophic epilepsy and epileptic spasms underwent leukotomies between 3 and 12 months of age. They were followed up postoperatively for 19–36 months. Both patients had 90%–100% seizure reduction and a significantly improved neurodevelopmental outcome without postoperative complication. Cortical malformation was seen in both patients. Modifications of established surgical disconnection techniques, tailored to each patient's specific epileptogenic zone, optimized seizure and neurodevelopmental outcomes while minimizing the risks associated with more extensive resections.

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Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric comorbidities in children with epilepsy, but it is under diagnosed and under treated which can impact the quality of life. Knowledge regarding ADHD characteristics, epilepsy-related risk factors, and associations with specific types of epilepsy provide a base for assessment. Epilepsy-related variables have not consistently predicted ADHD status, so screening and assessment for ADHD in children with epilepsy should be systematic and broad. Different assessment tools and techniques can be helpful including rating scales, diagnostic interviews, and neuropsychological testing. Treatment of ADHD with methylphenidate has been found to be safe and effective including in populations with uncontrolled seizures and coexisting intellectual disability. There are limited data on other medication and behavioral treatments. To improve assessment, diagnosis and treatment, medical provider knowledge, and practices, as well as family barriers to behavioral health should be targeted.

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Objective Sleep problems in children with FASD have not been well characterized. This study predicts that children with FASD and sleep problems will have more attention [Conner’s Continuous Performance Test (CPT)] and executive functioning [Brief Rating Inventory of Executive Functioning (BRIEF)] difficulties. Methods Data from 46 children (ages 3–14) diagnosed with an Alcohol Related Neurobehavioral Disorder whose parents completed the Sleep Disturbance Scale for Children (SDSQ) were reviewed. The sample was divided into two groups: low-sleep (T-score < 64) and high-sleep (T-score > 65) using the SDSQ Disorders of Initiating and Maintaining Sleep subscale. Results The FASD clinical population showed more sleep problems than average, t(45) = 6.64, p < 001. Children with high levels of sleep problems showed significantly higher ratings of inhibition than children with low sleep problems on the BRIEF Inhibit Scale, t(35) = −2.095, p = .043). They also showed a higher Global Executive Composite t(35) = −2.033, p = .05, although this finding may be influenced by elevations on the Inhibit Scale. Conclusion In conclusion, although parents are reporting more inhibition in daily life, there are no differences on neuropsychological measures suggesting that sleep difficulties do not lead to additional impairment in attention and executive functioning. Findings suggest that children with FASD have difficulties with attention and executive functioning regardless of sleep problems.