[Surgical treatment of epilepsies in children]

OBJECTIVE: To review the literature on surgical treatment of epilepsy in children. SOURCES: This review article is based on critical analysis of literature concerning epilepsy surgery for children. SUMMARY OF THE FINDINGS: In children and adolescents, developmental abnormalities and low-grade tumors predominate as causes and types of epilepsies. Extratemporal resections and hemispherectomies are common in pediatric series, and hippocampal sclerosis is rare. Seizure-free outcome is significantly less frequent after extratemporal or multilobar resection than after temporal resection in children than in adults, but the results are gratifying in both groups. Also, a global outcome, including parental satisfaction, developmental and social outcome, as well as activities of daily living (ADL), schooling, and behavioral changes should be considered. Pediatric epilepsy surgical series show that 60-100% of the patients have a good seizure outcome. Roughly 30 to 40% of patients improve some aspects of their behavior such as attention, aggressiveness, and hyperactivity and 16% of those start to attend school after surgery. Parents noted improvement of their social life in about 2/3 of children. CONCLUSIONS:Surgery for epilepsy has now become a realistic therapeutic option for selected children and the field is likely to increase in the near future. Surgical therapy should not be considered unless there is a reasonably good chance of improving the patientacute;s quality of life.