Thursday July 6, 2006Thursday July 6, 20067:30–9:00Hall 5ATeaching SessionEpilepsy surgery in infancy and childhood

¹ I. Tuxhorn (   ¹ Epilepsy Center Bethel, Germany )
Epilepsy surgery is no longer a treatment of last resort for children with drug resistant focal epilepsy. It should be considered early to reduce the negative impact of epilepsy on developmental and social outcome.
The spectrum of surgically remediable epilepsy syndromes of childhood has expanded in recent years to include 1) patients with tuberous sclerosis who have a leading resectable focus, 2) infantile spasms or Lennox-Gastaut syndrome (or other age specific epileptic encephalopathies) secondary to a resectable epileptogenic zone and 3) formerly "cryptogenic" cases with very subtle cortical dysplasias.
The goal of the presurgical evaluation is to identify patients who have surgically treatable epilepsy by assessing the risk benefit scenario of surgical intervention.
The accepted standards of evaluation include seizure analysis with video monitoring and scalp recording of the interictal and ictal EEG, high resolution MRI, neuropsychology, WADA test for assessing laterality of mnestic and language functions. Functional imaging including PET, ictal SPECT, postprocessing MRI techniques and fMRI are important techniques to evaluate difficult extratemporal cases.
The role of invasive neurophysiology with subdural, epidural and intracerebral recordings is changing since the advent of functional imaging of the epileptogenic region e.g., EEG triggered MRI and methods outlined above.
Patients with a focal electroclinical syndrome and a congruent MRI lesion are excellent candidates for selection and the seizure outcome prognosis may be considered high if the epileptogenic zone is completely resectable.
In pediatric epilepsy early patient referral for presurgical evaluation should be considered in specific syndromes—catastrophic focal epilepsy, hemispheric syndromes, Sturge Weber syndrome, and well localized symptomatic epilepsies.