Pre-surgical evaluation of intractable epilepsy in children

ABSTRACT

This review summarizes some patterns of pre-surgical evaluation of epilepsyin children with medically refractory seizures. Epilepsy surgery is a valuabletherapeutic option for many children with intractable epilepsy. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the area of ictal onset and initial seizure propagation [the epileptogenic zone]. EEG monitoring continues to prove indispensable in pre-surgical planning of refractory epileptic patients by defining the epileptogenic zone. Technological progresses in both structural and functional neuroimaging techniques have ledmany medical centers to consider surgical treatment of epilepsy. In children undergoing pre-surgical evaluation, the goals of neuroimaging studies include the identification of structural abnormalities in the brain, eloquent regions of the brain including language, memory, and sensorimotor functions, and the relation of these regions to the potential epileptogenic region. Neuropsychological testing plays a crucial role in assessing the potential impact of surgery on cognitive function of the patients and helps in lateralizing the cerebral hemisphere dominant for verbal and nonverbal function in older children. The Wada testis an invasive procedure to determine language dominance and can be used to assess the risk of postoperative memory deficits in children with temporal lobe epilepsy. Some children scheduled for resection still need to undergo further precise localization of the epileptogenic zone and functional mapping with invasive EEG monitoring through intracranial subdural grid and/or depth electrodes. Epilepsy surgery has the potential of changing the life quality of children by improving or eliminating seizures in carefully selected patients