Selection and Evaluation of the Pediatric Epilepsy Surgical Candidates
Batool F. Kirmani,
Edwin Darrell Crisp.
Pediatric patients who have failed two or more medications are less likely to respond to medical management. Intractable epilepsy leads to neurological deterioration and cognitive deficits. In this modern age of new technology, it is better to evaluate these patients for early resection of the seizure focus. Patients with an identifiable lesion on imaging and a localized seizure focus detected during intensive seizure monitoring have much higher chances of seizure freedom than with medical management alone. It has also been shown that pediatric epilepsy surgery has improved the quality of life of patients and reduced burden on the caregivers. The selection of candidates for surgery includes a battery of tests. Inpatient video EEG monitoring and phase 2 intracranial EEG monitoring for precise seizure localization are the most important tests. The other tests include neuropsychological and WADA testing to predict and protect against any deficits in memory and language post surgery. Specialized epilepsy centers also have functional MRI (fMRI) to supplement the WADA test. Other specialized imaging techniques including brain MRI with seizure protocol, SPECT, interictal and Ictal SPECT and PET scans are utilized to identify the responsible lesions. Based on the results of the testing, patients can undergo epilepsy surgery. The most common epilepsy surgeries are temporal lobectomies, lesionectomies, extratemporal resections, corpus callosotomies, subpial transections and functional hemispherectomy. The decision regarding the type of epilepsy surgery depends on the localization of the seizure focus.
Keywords: Epilepsy Surgery, Video-EEG monitoring, Intracranial EEG, SPECT, PET, Functional MRI, WADA test
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