Pre-surgical evaluation of intractable epilepsy in children

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 effectivetreatment for intractable partial epilepsy is a focal cortical resection with excisionof the area of ictal onset and initial seizure propagation (the epileptogenic zone).EEG monitoring continues to prove indispensable in pre-surgical planning ofrefractory epileptic patients by defining the epileptogenic zone. Technologicalprogresses in both structural and functional neuroimaging techniques have ledmany medical centers to consider surgical treatment of epilepsy. In childrenundergoing pre-surgical evaluation, the goals of neuroimaging studies includethe identification of structural abnormalities in the brain, eloquent regions of thebrain including language, memory, and sensorimotor functions, and the relationof these regions to the potential epileptogenic region. Neuropsychological testingplays a crucial role in assessing the potential impact of surgery on cognitivefunction of the patients and helps in lateralizing the cerebral hemispheredominant for verbal and nonverbal function in older children. The Wada testis an invasive procedure to determine language dominance and can be usedto assess the risk of postoperative memory deficits in children with temporallobe epilepsy. Some children scheduled for resection still need to undergofurther precise localization of the epileptogenic zone and functional mappingwith invasive EEG monitoring through intracranial subdural grid and/or depthelectrodes. Epilepsy surgery has the potential of changing the life quality ofchildren by improving or eliminating seizures in carefully selected patients.