Epilepsy Surgery for Children

  • Incidence of childhood epilepsy is ~40-100/100,000; prevalence is ~ 3.9/1,000
  • ~20 % will be surgical candidates
  • Potentially thousands of children who can be helped with surgery
  • What is medically refractory epilepsy in a child?
    • Failed 2 or more AED's at appropriate levels
    • Developmental regression or delay
    • The definition has evolved
    • "The clock is ticking"

Rationale for Surgery

  • exploit brain development and plasticity/synaptogenesis
  • impact of seizures on developing brain/ postictal and interictal effects (epileptic encephalopathy)
  • "Kindling"- stimulation of aberrant synaptic connections/additional epileptogenic foci
  • long-term consequences: deficits in learning, memory, behavior; social, economic, educational impact; low self esteem, poor academic performance, behavioral disturbances
  • combination of factors- CNS pathology, chronic seizures, AEDs
Authored By: 
Howard L. Weiner MD
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Authored Date: 
06/2004