Epilepsy Surgery in Children

Epilepsy is a neurological condition that accompanies mankind probably since its inception. About 400 years before Christ, the disease was already known by Hippocrates, who wrote the book “On The Sacred Disease”, in which it refuted the idea that the upheaval was the work of spirits and wisely related to brain. This concept was not fully accepted until modern era (Horsey, 1886). Classically, epilepsy is defined as a chronic disease with recurrent seizures, that affects individuals in all age groups, and affects 1-2% of children (Rasmussen, 1983). In childhood, epilepsy is more common in the first year of life, and its incidence decreases progressively with increasing age, affecting approximately 100 children per 100,000 births in the first year of life, 40 children for every 100,000 births in subsequent years, and approximately 20 individuals per 100,000 adolescents (Obeid et al, 2009a). In 75% of these cases, seizures are well controlled with antiepileptic drugs and in the remaining 25%, epilepsy is refractory to pharmacological treatment and surgical approach should be considered (Terra-Bustamante et al, 2005). The definition of intractability is not easy and many factors such as age of epilepsy onset, classical evolution of the specific epileptic syndrome, seizure frequency and epilepsy etiology should be considered. The goal of epilepsy surgery is complete resection of the epileptogenic zone, thus allowing patients to a greater chance of cure or disease control, with a better behavioral, cognitive and intellectual development, especially when considering the pediatric group. In these lines, early indication for surgery may allow children have better development and social inclusion (Lippé et al, 2010). It is estimated that 90% of brain growth and maturation occur until five years of age and intense dendritic synaptic connections remained until the age of seven, making this a favorable period for better post-operative recovery. In children the occurrence of neuronal plasticity is maximal and several eloquent cortical areas have great ability to reorganize its circuits, and can be functionally represented in both cerebral hemispheres (Obeid et al, 2009a; Benifla et al, 2009). It is known that the early indication for surgery is the single most important factor in getting good results, and that anti-epileptic drugs do not alter the long-term prognosis of epilepsy drug resistance, therefore, surgical treatment should not be postponed. When considering epilepsy surgery, some concepts should be established to achieve better seizure control (Obeid et al, 2009b): Epileptogenic zone: cortical area responsible for seizure generation, whose removal is sufficient to leave patient seizure free.