Panel Discussion

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Question: Do you think IQ should be used as a criterion in evaluating children and adolescents for epilepsy surgery?

Dr. Wyllie: Mental retardation of a moderate or severe degree makes us worry about diffuse brain disease, and perhaps a slightly worse outcome after epilepsy surgery of all types, as Dr. Spencer mentioned. With all types of epilepsy surgery, however, we have to keep in mind a specific goal for improved lifestyle that we think could be realistically accomplished by improvement of the seizures after surgery. This is somewhat different for high-functioning children with temporal lobe epilepsy compared to moderately or severely retarded children with corpus callosotomy. But, in either case, we have to have some realistic expectation that lifestyle would be improved. Sometimes mental retardation is a factor in our assessment, but if the EEG evidence and all the other clinical and radiographic evidence suggest that there is a single resectable focus, and if the child meets the other criteria for this type of epilepsy surgery, then my personal feeling is that mental retardation should not be a contraindication.

Dr. Andermann: There were many centers which would not consider surgery for a retarded child. Dr. Rasmussen's dictum was that it was always easier to look after somebody who was retarded but had no seizures rather than to look after somebody who was retarded and had seizures as well; thus retardation is not a criterion of exclusion for us.

Question: What is a staged procedure for callosotomy? If a good result. . .



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