The place of epilepsy surgery in children

There are approximately 100000 children in the UK with active epilepsy. Approximately 25% will remain intractable to medical therapy. For a significant proportion of these patients, (lo-20%) surgical treatment offers the potential to stop, or at least alleviate the seizure disorder. Realisation that the outlook of such a chronically disabling condition can be radically improved has led to a marked increase in paediatric epilepsy surgery both in Europe and North America,’ and an expansion of these UK neurosciences facilities is in progress. The basic principle of epilepsy surgery is to identify a well local&d epileptogenic abnormality responsible for the patient’s seizures, in an area of brain which can be removed, without resulting in a significant neurological deficit. In some patients in whom this is not possible, alternative techniques, such as interruption of pathways of seizure propagation may be considered (Table 1). The place of epilepsy surgery requires consideration of the rationale for early surgical intervention and the methods of identifying suitable children.