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
