Presurgical evaluation in patients with catastrophic epilepsy

Abstract

Publisher Summary This chapter discusses the common etiologies of catastrophic epilepsy across various age groups, diagnostic and presurgical evaluation, and identification of candidates for epilepsy surgery. Epilepsy surgery is a well-established treatment for catastrophic localization-related epilepsy in infants and children. All children with catastrophic epilepsy, regardless of age, must be promptly evaluated for diagnosis and presurgical evaluation. The risk–benefit ratio should then be cautiously weighed for every child in the light of several complex age-related issues. Young age entails special challenges for presurgical evaluation, but it also provides a great opportunity to attain early freedom from daily seizures and a chance to achieve the maximum cognitive potential. The presurgical evaluation of complex cases is best done at specialized centers with extensive pediatric epilepsy surgery experience. The three elements for candidacy for epilepsy surgery are: intractable disabling epilepsy; localizable epileptogenic zone; and low risk of new, unacceptable, and postoperative neurologic deficits. However, in comparison to adults, surgical consideration in children with catastrophic epilepsy is challenging and requires careful analysis of several complex age-related issues.