title: Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery.
abstract: Epilepsy is a common disease in the pediatric population, and the majority of cases are controlled with medications and lifestyle modification. For the children whose seizures are pharmacoresistant, continued epileptic activity can have a severely detrimental impact on cognitive development. Early referral of children with drug-resistant seizures to a pediatric epilepsy surgery center for evaluation is critical to achieving optimal patient outcomes. There are several components to a thorough presurgical evaluation, including a detailed medical history and physical examination, noninvasive testing including electroencephalogram, magnetic resonance imaging (MRI) of the brain, and often metabolic imaging. When necessary, invasive diagnostic testing using intracranial monitoring can be used. The identification of an epileptic focus may allow resection or disconnection from normal brain structures, with the ultimate goal of complete seizure remission. Additional operative measures can decrease seizure frequency and/or intensity if a clear epileptic focus cannot be identified. In this review, we will discuss the nuances of presurgical evaluation and decision-making in the management of children with drug-resistant epilepsy (DRE).
authors.affiliation: Department of Neurosurgery, University of Vermont School of Medicine, Burlington, VT, USA; ; Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Ducis
authors.affiliation: Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Karsy
authors.affiliation: Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA; ; Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bollo
keywords: Drug-resistant; epilepsy; pediatric; seizure focus; surgery