The Principles of Surgical Treatment in Pediatric Epilepsy: Intractability to Medication, Determination of Potential Surgical Candidates and Advanced Techniques That Were Used for in Pediatric Epilepsy

Abstract

Summary Majority of the epileptic syndromes in children are consisted of epilepsies arising from extratemporal lobes often associated with developmental abnormalities. Almost all the epilepsies in this group are associated with refractory seizures that require early consideration of surgical cure. Differences in the semiological and EEG properties of the seizures in the younger age group as compared to adults’ influence the decision of the surgical tecnique preferred. Seizure monitorizations of candidates are performed in comprehensive epilepsy centers. Highresolution MRIs and functional imaging techniques (PET, SPECT, fMRI) are used with spesific purposes. The main goal of epilepsy surgery is to stop the seizures without additional neurological deficit. However, in some situations like in the control of catastrophic seizures in small children, extensive resections such as hemispherectomy may be needed; yet plasticity may reduce the deficits, which were resulted from surgery to the minimum. In some special circumstances, palliative surgeries (corpus callosotomy, multiple subpial transections) could be performed to protect the patients from negative effects of multiple antiepileptics and the refractory seizures. Therefore, surgical treatments have to be chosen specifically for each patient.