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Abstract

Dr. Andermann: In recent years, we have seen a tremendous upsurge of interest in the surgical treatment of epilepsy. One reason is that the treatment of generalized epilepsy has improved so much with the advent of better drugs and better utilization of these drugs. Patients with intractable seizures tend to stand out much more, and failure of medical treatment in these patients is quite obvious.

Two years ago, there were about 50 centers in the world where surgical treatment of epilepsy was being carried out; there are probably at least twice as many now.

One of the main issues when considering surgery in children is the evaluation of the likelihood that the attacks will cease spontaneously. One important factor is that the seizure pattern should be stable and not change over time. The prevention of behavioral complications is also important; it is, of course, a major concern in the treatment of children with intractable epilepsy. When there is manifest deterioration, either from a cognitive or from a behavioral point of view, one should seriously consider the possibility of a surgical approach.

In the past, several people, including Rasmussen, have evaluated the results of surgical treatment in children. He found that in the Montreal Neurological Institute series about 10% of the patients who had a temporal lobectomy for treatment of epilepsy were children. In a series of about 800 patients, there were 77 children below the age of 16 years. The results were very similar to the ones in adults. Similarly,. . .


 

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