Severe epilepsy in children: The role of surgical treatment

Epilepsy surgery represents an effective and safe treatment option in children with drug-resistant seizures. The indications for epilepsy surgery are the following: a) pharmacoresistance; b) severe epilepsy and possible disturbances in cognitive functions and behaviour; c) delineation of a single, well delimited and surgically approachable epileptogenic zone. Etiology and syndromes amenable to surgery are much more heterogeneous in children than in adults. The rates of seizure freedom after surgery in children range from 60% to 80%. Early surgical intervention may have a beneficial effect on cognitive performances and behaviour. Factors predicting a favourable outcome in paediatric epilepsy include a single lesion on MRI, especially in the temporal lobe and complete resection of the lesional area and the epileptogenic zone. Children with drug-resistant seizures should be referred to paediatric epilepsy centers with dedicated expertise in presurgical evaluation as soon as possible in order to identify the best surgical candidates and define the optimal timing for surgery.