Outcome of epilepsy surgery in children

Surgery in childhood is presently an established therapeutic option for medically resistant seizure disorders. Focal resection, midline commissurotomy and modified hemispherectomy are three procedures which have all achieved a measure of success in the pediatric patient. For all these procedures, seizure status improves to a degree at least comparable and probably superior to that of adults. The incidence of complications is not negligible but the benefits of surgery would appear to outweigh their risks in view of the longterm adverse consequences of uncontrolled seizures. Many questions still await further study - the criteria for case selection, methodology for presurgical evaluation and the surgical techniques themselves all require careful study and standardization. The natural history of all the childhood epilepsies and the optimal time of surgery in the neurodevelopmental continuum is also unknown. Given the capacity of the immature brain for neural reorganization, surgery may be an option in the very youngest patients when plasticity and recovery of function is maximal rather than jeopardizing psychosocial development by postponing surgery. Answers to these important questions would considerably advance the outlook of children with chronic seizure disorders.