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Epilepsy Surgery in Childhood

Published online by Cambridge University Press:  02 December 2014

Valeria L. Muro  and
Mary B. Connolly
Valeria L. Muro
Affiliation:
Division of Pediatric Neurology, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
Mary B. Connolly*
Affiliation:
Division of Pediatric Neurology, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
*
Division of Pediatric Neurology, K3-179, Ambulatory Care Building, British Columbia's Children's Hospital, 4480 Oak Street Vancouver, British Columbia, V6H 3V4, Canada
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Abstract

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Historically, epilepsy surgery has been considered a treatment of last resort. Advances in neuroimaging, particularly high resolution magnetic resonance imaging (MRI) techniques and functional neuroimaging, advances in neuroanesthesia and neurosurgery have all contributed to the development of safe and effective epilepsy surgery in infants and children. Furthermore, epilepsy surgery may prevent the chronic deleterious effects that uncontrolled epileptic seizures have on brain development. The main challenges that clinicians face are early identification of infants and children who have epilepsy which is amenable to epilepsy surgery, the timing of epilepsy surgery and the investigation of patients where no lesion is demonstrable on MRI. It is imperative that children be followed after epilepsy surgery to assess the long-term outcomes not only in relation to seizure control, but also to assess quality of life, psychoeducational achievement, and psychiatric co-morbidity.

Résumé

RÉSUMÉ

Historiquement, la chirurgie de l'épilepsie était considérée comme un traitement de dernier recours. Les progrès en neuroimagerie, particulièrement les techniques d'imagerie par résonance magnétique de haute résolution (IRM) et la neuroimagerie fonctionnelle, les progrès en neuroanesthésie et en neurochirurgie ont contribué au développement de la chirurgie de l'épilepsie qui est maintenant sûre et efficace chez les nourrissons et les enfants. De plus, la chirurgie de l'épilepsie peut prévenir les effets chroniques délétères que certaines crises épileptiques non contrôlées ont sur le développement du cerveau. Le principal défi que les cliniciens rencontrent sont l'identification précoce des nourrissons et des enfants qui ont une épilepsie traitable chirurgicalement, le moment d'effectuer cette chirurgie et l'évaluation des patients chez qui l'IRM ne détecte pas de lésion. Il est essentiel que les enfants soient suivis après la chirurgie de l'épilepsie afin d'évaluer les résultats à long terme, non seulement quant au contrôle des crises, mais aussi pour évaluer la qualité de vie, le niveau psychoéducatif atteint et les comorbidités psychiatriques.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue S6 , November 2012 , pp. S35 - S39
Copyright
Copyright © The Canadian Journal of Neurological 2012

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