Evolution of epilepsy surgery in childhood: the neurologist's point of view

Abstract

Surgical treatment of epilepsy in children has been slow to develop because of uncertainties regarding the prognosis of early epilepsies, difficulties in the diagnosis of causal lesions, the frequency of severe, extensive brain damage, and technical problems. Surgery for epilepsy in infants and children raises problems quite different from those in adults. This applies especially to severe infantile epilepsies for which the aim of treatment may be more to facilitate neurodevelopment than to control the seizures. In addition, intractability cannot be defined in the same terms at different ages, the time scale being usually much shorter in young children and the operations required often extensive. The results of surgery in childhood are comparable to those in adults. However, indications for surgery and assessment of its results in catastrophic epilepsies of infants requires different rules to those that apply to adults and older children.