Epilepsy Surgery for Children

• Incidence of childhood epilepsy is ~40-100/100,000; prevalence is ~ 3.9/1,000
• ~20 % will be surgical candidates
• Potentially thousands of children who can be helped with surgery
• What is medically refractory epilepsy in a child?
• Failed 2 or more AED’s at appropriate levels
• Developmental regression or delay
• The definition has evolved
• “The clock is ticking”

Rationale for Surgery

• exploit brain development and plasticity/synaptogenesis
• impact of seizures on developing brain/ postictal and interictal effects (epileptic encephalopathy)
• “Kindling”- stimulation of aberrant synaptic connections/additional epileptogenic foci
• long-term consequences: deficits in learning, memory, behavior; social, economic, educational impact; low self esteem, poor academic performance, behavioral disturbances
• combination of factors- CNS pathology, chronic seizures, AEDs

Reviewed and revised June 2004 by Howard L. Weiner, MD, FACS, FAAP, Associate Professor of Neurosurgery & Pediatrics, Division of Pediatric Neurosurgery, NYU School of Medicine