Recent Aspects of Pediatric Epilepsy Surgery

Abstract

Surgery has been and is now a well-established treatment indicated for adults and children with drug-resistant epilepsy (DRE). The surgical landscape for children with DRE appears to be expanding, and surgical cases of pediatric epilepsy have increased significantly in the past decade, contrary to adult epilepsy. Several fundamental changes have led to the widespread surgical treatment for DRE in children, based on a risk-benefit analysis of pediatric epilepsy surgery, and a change in our overall approach to evaluation. There are unique and age-related differences associated with pediatric epilepsy surgery, characterized by different types of etiologies, concerns for developmental progress, and safety issues. Indications for "pediatric epilepsy surgery" have been broadened to include a wide spectrum of etiologies without excluding children with "generalized" seizures, "generalized or multifocal eletroencephlography", or patients with contra-lateral epileptiform activity or magnetic resonance imaging abnormalities. Furthermore, epilepsy surgery is increasingly considered in infancy and early childhood, which has similar surgical outcomes as the case of late childhood, in an effort to improve the eventual development outcome. Seizure freedom, or at least seizure reduction, is an excellent result with resolution of the associated epileptic encephalopathy, normalization of the EEG, and decrease in the total epileptic burden in the pediatric field.

Effectiveness and Safety of Epilepsy Surgery for Pediatric Patients with Intractable Epilepsy: A Clinical Retrospective Study from a Single-Center Experience

“…In the literature, mortality rates in pediatric epilepsy surgery tend to range from 1 to 2%, as reported by Kwon in 2019 [12]. Our study correlates these results with a mortality rate of 1.6% ( n = 1).…”

“…It has been reported that the most common cause of pediatric epilepsy patients who undergo surgery is focal CD. The second most common cause is intracranial tumors [12]. Even though more patients with CD would be expected than intracranial tumors, the same number of cases were noted ( n = 11).…”

“…MTS is another significant cause of DRE. Even though it is not as prevalent as it is in adults, MTS is still the third leading cause of DRE, following CD and intracranial tumors [12]. There have been different approaches suggested over the years for cases of MTS, such as ATL or SAH.…”

A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India

“…Generalized seizures, generalized multifocal encephalography, contralateral epileptiform activity, and MRI abnormalities are some of the conditions that indicate surgeries. 53 In patients with focal cortical dysplasia (FCD) during pretreatment evaluation, there might be a 30 to 40% chance of negative MRI results; however, in such cases, surgeries are also preferred. Poorly controlled seizures and negative therapeutic outcomes are contributing factors for surgical options.…”

“…Recent advancements in presurgical evaluation and perisurgical management provide better opportunities for earlier surgeries. 53…”