title: Early-onset symptomatic focal epilepsy: a dilemma in the timing of surgery.
abstract: We report the case of a six-year-old boy who presented in infancy with infantile spasms and left focal seizures. An MR scan at two months was suggestive of a right parietal cortical dysplasia, although this was less apparent on repeat scan at 11 months. The initial response to anti-epileptic medications was good; surgery was therefore deferred at that time. Subsequently, seizure control fluctuated and developmental progress was, on the whole, good. However, ultimately seizures increased despite changing the AED, and he began showing developmental problems. Surgery was reconsidered. Again, a repeat MR scan did not define the lesion well. Following full further evaluation, including functional imaging that still implicated the right parietal cortex, subdural grid and depth electrode monitoring were undertaken at 6.5 years, which located the ictal onset zone deep within the lesion. This enabled a right inferior parietal lobe resection to be performed. Four years post-surgery he remains seizure-free and has shown progress in development.
authors.affiliation: Great Ormond Street Hospital for Children NHS Trust & UCL-Institute of Child Health, London, England.
authors.forename: Neely
authors.initials: N
authors.lastname: Desai
authors.forename: Ronit M
authors.initials: RM
authors.lastname: Pressler
authors.forename: Nicola
authors.initials: N
authors.lastname: Jolleff
authors.forename: Maria
authors.initials: M
authors.lastname: Clark
authors.forename: Brian
authors.initials: B
authors.lastname: Neville
authors.forename: Christin
authors.initials: C
authors.lastname: Eltze
authors.forename: William
authors.initials: W
authors.lastname: Harkness
authors.forename: J Helen
authors.initials: JH
authors.lastname: Cross
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002657:Child Development; D004351:Drug Resistance; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010296:Parietal Lobe / Q000473:pathology; D012640:Seizures / Q000503:physiopathology; D013036:Spasms, Infantile / Q000150:complications; D013686:Telemetry
chemical_list: D000927:Anticonvulsants