SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR PARTIAL (FOCAL) SEIZURES – GENERAL CONSIDERATIONS FOR SURGERY

Partial seizures, or partial seizures that secondarily generalize are, by definition, always focal (local) in origin. Any child with partial (focal) seizures deserves some evaluation to find the source of the focal abnormality. If the EEG shows focal slowing or if the child has had several seizures that seem to start from the same area of the brain, then the child should have a CT or MRI scan searching for a focal, structural problem that might require surgery. Surgery is rarely considered in the child who has had only a few seizures unless there is a tumor or vascular abnormality—rare causes of seizures in children— and then the surgery done is “tumor” surgery. Douglas, whom we discussed above, was a child with a structural problem who benefited from surgery early in the course of his epilepsy and who was cured by the procedure.

In the absence of a tumor or vascular abnormality, trials of medication are indicated to try to control focal seizures. If the seizures remain persistently focal, then the option of surgery should be considered. Considering the option is not the same as pursuing that option, but whereas only a few years ago surgery was not even contemplated until medication trials had been exhausted, now the new techniques for evaluation, as well as the advances in surgical technique, have made surgery a more reasonable and desirable alternative to lifelong medication, even if that medication controls the seizures.

Consideration for surgery is a multiphased process. It proceeds step-by-step. The process can be stopped at any step if evidence suggests that the child is not a good candidate for surgery.

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SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR PARTIAL (FOCAL) SEIZURES – GENERAL CONSIDERATIONS FOR SURGERYPartial seizures, or partial seizures that secondarily generalize are, by definition, always focal (local) in origin. Any child with partial (focal) seizures deserves some evaluation to find the source of the focal abnormality. If the EEG shows focal slowing or if the child has had several seizures that seem to start from the same area of the brain, then the child should have a CT or MRI scan searching for a focal, structural problem that might require surgery. Surgery is rarely considered in the child who has had only a few seizures unless there is a tumor or vascular abnormality—rare causes of seizures in children— and then the surgery done is “tumor” surgery. Douglas, whom we discussed above, was a child with a structural problem who benefited from surgery early in the course of his epilepsy and who was cured by the procedure.In the absence of a tumor or vascular abnormality, trials of medication are indicated to try to control focal seizures. If the seizures remain persistently focal, then the option of surgery should be considered. Considering the option is not the same as pursuing that option, but whereas only a few years ago surgery was not even contemplated until medication trials had been exhausted, now the new techniques for evaluation, as well as the advances in surgical technique, have made surgery a more reasonable and desirable alternative to lifelong medication, even if that medication controls the seizures.Consideration for surgery is a multiphased process. It proceeds step-by-step. The process can be stopped at any step if evidence suggests that the child is not a good candidate for surgery.*153\208\8*

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