Paediatric epilepsy surgery; the earlier, the better
Braun, K.P.J.; van Eijsden, P.
Nederlands Tijdschrift Voor Geneeskunde 162: D2587
2018
ISSN/ISBN: 1876-8784 PMID: 29600929 Document Number: 695609
The first randomised trial of paediatric epilepsy surgery demonstrated what was already known for decades among physicians of children with refractory epilepsy: surgical treatment is a highly successful treatment option with superior efficacy compared to ongoing drug treatment in well-selected surgical candidates. The lack of equipoise and the design of the trial - in which half of the children had to wait for one year before being offered surgery - raises questions about its ethical justification. A shorter duration of epilepsy predicts better cognitive and seizure outcomes after surgery. Surgical risks are low, seizure-freedom rates are high for specific pathologies, and the chance of spontaneous permanent remission is low in children with focal lesional epilepsy. These children should be referred for presurgical evaluation early after diagnosis. Benefits of surgery may outweigh the limited surgical risks when the lesion is located outside eloquent brain areas, even when seizures are well controlled with antiepileptic drugs.