Pediatric Epilepsy Surgery

In 1997, Jean AICARDI, one of the most brilliant child neurologists of our
era, commented on "How the view has changed" in the field of pediatric
epilepsy surgery: "Surgery for epilepsy has now become a realistic therapeutic
option for selected children and the field is likely to increase in the near
future. It is now realised that procrastination, in the hope that new
antiepileptic drugs will become efficacious, is not justified for some forms
of epilepsy that can often be recognised from onset or after a relatively
short course. It is also becoming clear that surgery is not reserved for a
highly selected population of patients with normal intelligence and focal
seizures, but may also help a proportion of more severe epilepsies if a
realistic view of the problem and perspectives is taken by the partners".

Twenty years later, the most obvious and probably still the strongest reasons
against epilepsy surgery in children are cultural and psychological. This
book, written by members of the ad hoc ILAE Task Force for pediatric epilepsy
surgery and experts in the field, is the result of continued collaborative
working between pediatric epilepsy surgery centres over the years. Authors
critically review all available data and set out the key elements of
presurgical evaluation, the specific electro-clinical presentations per
etiology, the range of outcomes to be monitored, and the surgical techniques
used today.

What becomes obvious when reviewing all available data is that the key to
optimized outcome in children with epilepsy is early appropriate recognition
of possible surgical candidates and timely referral to centres with expertise.