Surgery for Intractable Epilepsy: Issues and Outcome

Abstract

For certain forms of childhood epilepsy that remain uncontrolled despite adequate treatment with standard antiepileptic medication, surgical therapy should be considered as a potential avenue of treatment. The prognosis for seizure control after early surgery is generally favorable and is at least comparable with that of adults. Remissions are often long-standing or permanent. The results are particularly beneficial if a discrete region of abnormal epileptogenic tissue can be excised. The three major procedures—focal resection, corpus callosotomy, and hemispherectomy—have all been performed successfully in children, and their complication rates are low. With the exception of the obvious benefit conferred by alleviating seizures at a younger age, earlier surgery also improves later psychosocial status and adaptive function. By contrast, persistent seizure activity decreases the likelihood of achieving a functionally independent and economically productive adult life. The psychosocial benefits therefore constitute the most important argument in favor of early surgical intervention. Although relatively little is known about the neuropsychologic consequences of early surgery, there are few deleterious long-term cognitive or behavioral deficits if surgery is uncomplicated. However, relatively little is known about neural reorganization after early surgical excision or hemispheric disconnection, and this remains the greatest challenge for the future.