Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery

Abstract

Epilepsy is a common disease in the pediatric population, and the majority of cases are controlled with medications and lifestyle modification. For the children whose seizures are pharmacoresistant, continued epileptic activity can have a severely detrimental impact on cognitive development. Early referral of children with drug-resistant seizures to a pediatric epilepsy surgery center for evaluation is critical to achieving optimal patient outcomes. There are several components to a thorough presurgical evaluation, including a detailed medical history and physical examination, noninvasive testing including electroencephalogram, magnetic resonance imaging (MRI) of the brain, and often metabolic imaging. When necessary, invasive diagnostic testing using intracranial monitoring can be used. The identification of an epileptic focus may allow resection or disconnection from normal brain structures, with the ultimate goal of complete seizure remission. Additional operative measures can decrease seizure frequency and/or intensity if a clear epileptic focus cannot be identified. In this review, we will discuss the nuances of presurgical evaluation and decision-making in the management of children with drug-resistant epilepsy (DRE).

Stereoelectroencephalography in Pediatric Epilepsy Surgery

“…The goal of epilepsy surgery is to disrupt this network through resection, disconnection, targeted ablation, neurostimulation, or some combination thereof. In some cases, non-invasive evaluation is sufficient to determine the surgical plan, but children frequently require invasive exploration with intracranial electrodes to achieve high-resolution delineation of the EZ and nearby eloquent cortices [33].…”

Added Value of NeuroGam Software Analysis in Single Photon Emission Computed Tomography Localization Diagnosis of Epilepsy in Interictal Stage

“…As some patients are not sensitive to antiepileptic drugs and develop drug resistant epilepsy, surgical treatments, such as epileptogenic zone resection, are critical for effectively controlling epilepsy; the key to the success of operation is the diagnostic localization of the epileptogenic zone [ 2 ]. Although invasive intracranial electroencephalogram recording is the gold standard for epilepsy localization [ 3 ], the method is invasive and has surgical risks.…”