Epilepsy surgery

Surgery is considered for children with medically intractable epilepsy or declining neurological function, or for syndromes for which medical treatment is known to be ineffective. These determinations require accurate classification of the epilepsy syndrome, knowledge of the natural history, response to AED trials, and serial assessments of development. Many types of infantile and early childhood epilepsies are hard to classify and of uncertain prognosis. Therefore, it is not surprising that surgical outcome is best with older children and adolescents who have focal cerebral lesions or mesial temporal sclerosis. There is growing interest, however, in operating earlier, especially in selected patients who have catastrophic epilepsy. [Altunbasak: 2007]

Children in whom surgery is considered should have a reasonable expectation of seizure elimination or substantially fewer disabling seizures, translating into improved quality of life and perhaps development. There should be minimal risk of losing neurologic function. The definition of intractable is not necessarily the same for all patients. In practical terms, this may be a failure to respond to three well-selected AEDs, used in isolation or in any combination. Because the frequency of seizures in children is often high, this determination need not take years and, often, can be established within a year of onset of the epilepsy. Children with complete resections of focal structural lesions, identified by MRI, fare best, with seizure-free rates as high as 90%. Many of these lesions are congenital slow-growing tumors or cerebral dysgenesis. Mesial temporal sclerosis (a common indication in adult epilepsy surgery) is infrequent in children and adolescents. Without a clear MRI focus, complete long-term seizure freedom is achieved in less than half of patients.

The three main types of epilepsy surgery include:
  • temporal or partial temporal lobectomy/lesionectomy - successful in many. The percentage of cure or signifcant seizure reduction varies with different criteria/methods used. [Sotero: 2001]
  • corpus callosotomy - used most often for drop attacks or generalized tonic-clonic seizures
  • hemispherectomy - more risks than with other surgeries, but sometimes remarkably successful. Loss of function will occur on side of body opposite the removed hemisphere


Helpful Articles

Steinbok P, Gan PY, Connolly MB, Carmant L, Barry Sinclair D, Rutka J, Griebel R, Aronyk K, Hader W, Ventureyra E, Atkinson J.
Epilepsy surgery in the first 3 years of life: A Canadian survey.
Epilepsia. 2009. PubMed abstract

Benifla M, Rutka JT, Otsubo H, Lamberti-Pasculli M, Elliott I, Sell E, RamachandranNair R, Ochi A, Weiss SK, Snead OC 3rd, Donner EJ.
Long-term seizure and social outcomes following temporal lobe surgery for intractable epilepsy during childhood.
Epilepsy Res. 2008;82(2-3):133-8. PubMed abstract


Compiled and edited by: Lynne M. Kerr, MD, PhD - 6/2011

Page Bibliography

Altunbasak, S, Herguner, O, and Burgut, H R.
Risk factors predicting refractoriness in epileptic children with partial seizures.
Journal Child Neurology. 2007;22(2):195-199.

Sotero de Menezes MA, Connolly M, Bolanos A, Madsen J, Black PM, Riviello JJ Jr.
Temporal lobectomy in early childhood: the need for long-term follow-up.
J Child Neurol. 2001;16(8):585-90. PubMed abstract