title: Surgical Management of Pediatric Epilepsy: Decision-Making and Outcomes.
abstract: First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Surgical treatment of epilepsy can be critical to avoid negative outcomes in functional, cognitive, and behavioral health status. Furthermore, it is often the only method to achieve seizure freedom in refractory epilepsy. Although a large literature base can be found for adults with refractory epilepsy undergoing surgical treatment, less is known about how surgical management affects outcomes in children with epilepsy. The purpose of the review was fourfold: (1) to evaluate the available literature regarding presurgical assessment and postsurgical outcomes in children with medically refractory epilepsy, (2) to identify gaps in our knowledge of surgical treatment and its outcomes in children with epilepsy, (3) to pose questions for further research, and (4) to advocate for a more unified presurgical evaluation protocol including earlier referral for surgical candidacy of pediatric patients with refractory epilepsy. Despite its effectiveness, epilepsy surgery remains an underutilized but evidence-based approach that could lead to positive short- and long-term outcomes for children with refractory epilepsy.
authors: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina. Electronic address: kellerma@musc.edu.
authors: Tanja S
authors: TS
authors: Kellermann
authors: College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
authors: Janelle L
authors: JL
authors: Wagner
authors: College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
authors: Gigi
authors: G
authors: Smith
authors: Division of Child Neurology and Pediatric Epileptology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors: Samir
authors: S
authors: Karia
authors: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
authors: Ramin
authors: R
authors: Eskandari
mesh_terms: D002648:Child; D000066491:Clinical Decision-Making; D000069279:Drug Resistant Epilepsy / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures; D010372:Pediatrics
keywords: pediatric epilepsy; presurgical evaluation; refractory epilepsy; surgical outcome