It has been demonstrated that intractable seizures in children can be eliminated or become more responsive to anticonvulsant medication after surgical resection of the epileptogenic focus or dysfunctional hemisphere. We describe our surgical experience with 4 infants treated at Children’s Healthcare of Atlanta Egleston Hospital between 1994 and 2002. All infants, ranging in age from 5 to 9 months, presented with severe seizure disorders and failed trials of anticonvulsants. All had preoperative EEG monitoring and MRI studies; 2 had PET functional imaging. One infant underwent a temporal resection for a low-grade glioma. The rest had cortical resections for malformations and dysplasia. All had improvement, with 2 infants free of seizures off medication. We argue for early intervention in severe cases, as the potential for recovery can be dramatic.

Keywords:
Epilepsy, Seizures, Infancy, Surgery
1.
Behrens E, Schramm J, Zentner J: Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 1997;41:1–10.
2.
Bizzi JWJ, Bruce DA, North R: Surgical treatment of focal epilepsy in children: Results in 37 patients. Pediatr Neurosurg 1997;26:83–92.
3.
Bourgeois M, Sainte-Rose C, Lellouch-Tubiana A: Surgery of epilepsy associated with focal lesions in childhood. J Neurosurg 1999;90:833–842.
4.
Carson BS, Javedan SP, Freeman JM: Hemispherectomy: A hemidecortication approach and review of 52 cases. J Neurosurg 1996;84:903–911.
5.
Chugani HT, Shewmon DA, Shields WD: Surgery for intractable spasms: Neuroimaging perspectives. Epilepsia 1993;34:764–771.
6.
Duchowny M: Epilepsy surgery: Identification of surgical candidates and timing of operation – An overview; in Wyllie E (ed): The Treatment of Epilepsy, ed 2. Baltimore, Williams & Wilkins, 1997, pp 967–975.
7.
Goldring S, Bernardo KL: Surgery of childhood epilepsy; in Dodson WE, Pellock JM (eds): Pediatric Epilepsy: Diagnosis and Therapy. New York, Demos, 1993.
8.
Humbertclaude VT, Coubes PA, Robain O: Early hemispherectomy in a case of hemimegalencephaly. Pediatr Neurosurg 1997;27:268–271.
9.
Kerrigan JF: Infantile spasms. BNI Q 1999;15(1).
10.
Adelson PD, Peacock WJ, Chugani HT: Temporal and extended temporal resections for the treatment of intractable seizures in early childhood. Pediatr Neurosurg 1992;18:169–178.
11.
Volpe JJ: Neonatal seizures; in Fletcher J (ed): Neurology of the Newborn, ed 3. Philadelphia, Saunders Co, 1995.
12.
Henry TR: Neuroimaging in epilepsy; in Tindall G (ed): Contemporary Neurosurgery. Philadelphia, Lippincott Williams & Wilkins, 1996, vol 18, pp 1–4.
13.
Wyllie E, Comair YG, Kotagal P: Epilepsy surgery in infants. Epilepsia 1996;37:625–637.
14.
Jayakar P, Duchowny M, Resnick TJ: Subdural monitoring in the evaluation of children for epilepsy surgery. J Child Neurol 1994;2:61–66.
15.
Kramer U, et al: Morbidity of depth and subdural electrodes: Children and adolescents versus young adults. J Epilepsy 1994;7:7–10.
16.
Kanner, AM, Kaydanova, Y, de Toledo-Morrell L, Morrell F: Tailored anterior temporal lobectomy: Relation to extent of resection of mesial structures and postsurgical seizure outcome. Arch Neurol 1995;52:173–178.
17.
Nayel MH, Awad IA, Luders H: Extent of mesiobasal resection determines outcome after temporal lobectomy for intractable complex partial seizures. Neurosurgery 1991;29:55–61.
18.
Chugani HT, Shewmon DA, Peacock WJ: Surgical treatment of intractable neonatal seizures: The role of positron emission tomography. Neurology 1988;38:1178–1188.
19.
Koo B, Hwang P: Localization of focal cortical lesions influences age of onset of infantile spasms. Epilepsia 1996;37:1068–1071.
20.
Duchowny MS, Jayakar P, Resnick TJ: Epilepsy surgery in the first three years of life. Epilepsia 1998;39:737–743.
21.
Wyllie E, Luders H, Morris HH: Clinical outcome after complete or partial cortical resection for intractable epilepsy. Neurology 1987;37:1634–1641.
22.
Wyllie E: Surgery for catastrophic localization-related epilepsy in infants. Epilepsia 1996;37(suppl 1):S22–S25.
23.
Duchowny MS, Resnick TJ, Alvarez LA: Focal resection for malignant partial seizures in infancy. Neurology 1990;40:980–984.
24.
Peacock WJ, Wehby-Grant MC, Shields WD: Hemispherectomy for intractable seizures in children: A report of 58 cases. Childs Nerv Syst 1996;12:376–384.
25.
Morell F, Hanbery J: A new surgical technique for the treatment of focal cortical epilepsy. Electroencephalogr Clin Neurophysiol 1969;26:120.
© 2003 S. Karger AG, Basel
2003
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