Kids with hard-to-manage seizures may be considered for epilepsy surgery when treatment with anti-epileptic medication fails. Neurosurgical intervention, even at an early age, can sometimes end frequent, uncontrollable seizures, allowing children to maximize their potential.
　　　　　
　　　　
　　　　
Epilepsies in Children 　　< back top >
　　　
　　　Epilepsies may occur throughout the lifespan - from the newborn to the elderly. Seizures are individual events or episodes, a symptom of a temporary "misfiring" in the brain. But when seizures occur again and again, the child is said to have epilepsy. In most cases of epilepsy, there is no specific acute cause. Instead, perhaps a minor brain injury in the period surrounding birth or an inherited tendency towards having seizures producing the episodes. Sometimes, head trauma or an infection which affected the brain (meningitis or encephalitis) at an earlier age produces slight scarring of the brain, with resulting seizures.
　　　
　　　Most children with epilepsy, or recurrent seizures, will benefit from treatment with anti-epileptic medications, which usually reduce seizure frequency or eliminate seizures. The majority of children are well between episodes and develop normally with few limitations.
　　　　　　

　　　　　　　　
When Consider Surgery For Children with Epilepsy? 　　< back top >
　　　　　
　　　A number of children face a more difficult course, influenced by factors including the type of seizure pattern, the age of onset, and the presence of associated conditions. Despite aggressive treatment with anti-convulsant therapy, some children experience uncontrolled, frequent seizures, or medically intractable epilepsy.
Consequences of intractable epilepsy include the possibility of physical injury during a seizure, impairment of learning and attention, adverse effects of medications, brain injury due to seizures and disruption of family life brought about by frequent medical crises. Any or all of these reasons, accompanied by concerns about quality of life and future development, may lead a family to think about neurosurgery to improve seizure control.
　　　
　　　Earlier Intervention for Medically Intractable Epilepsies of Childhood
Concerns about the impact of poorly controlled seizures and chronic use of anti-epileptic medications during a child's formative years have led both the medical community and parents to advocate for earlier neurosurgical intervention.
Sophisticated diagnostic techniques now available help us to better define the source of a child's seizures. The evolution of neurosurgical techniques have allowed us to maximize success while minimizing risk. At The Shenzhen Children's Hospital Comprehensive Epilepsy Center, as at all specialized epilepsy centers, we are strongly committed to providing early intervention. Our team of specialists includes pediatric neurosurgeons with advanced training in pediatric epilepsy surgery, pediatric neurologists with expertise in clinical neurophysiology and epilepsy, and state-of-the-art pediatric intensive care units.
　　　　
　　　　　
　　　　
Epilepsy Surgery for Children: At Glance 　　< back top >
　　　　　
　　　Epilepsy surgery in children serves either to remove the source of the seizures (resective surgery) or, in some cases, to disrupt pathways which spread seizures (disconnection surgery).
　　　
　　　In resective surgery, a team of epilepsy specialists work to identify the part or region of the brain which causes an infant's or child's seizures, and then remove this "epileptic zone". This is known as focal or cortical resection, and the area removed may be quite small, as in the area surrounding a small developmental abnormality, or more extensive. Much careful testing is done prior to surgery to both (a) identify the area of the brain causing the seizures, and (b) to make decisions regarding the extent of the surgery to bring about good seizure control, while preserving the child's existing abilities and potential.
　　　
　　　In disconnection surgery, seizure pathways are disrupted, therefore reducing their spread in the brain. The major type of disconnection surgery is corpus callosotomy, disruption of a structure which separates the two halves (hemispheres) of the brain. Another advanced technique is called multiple subpial transection, used for surgery in crucial areas of the brain which control speech and movement.
　　　　　
　　　　
　　　　
Resective Surgery in Children 　　< back top >
　　　　
　　　Specialists at The Shenzhen Children's Hospital Comprehensive Epilepsy Center work together to find evidence that points to a consistent part of the brain as the source of seizures in that particular child. The diagnostic testing done to identify the source of seizures may include:
　　　　
　　　* EEG, or electroencephalogram, records brain waves and often guides us in identifying areas of the brain which have abnormal electrical discharge. The EEG, even between seizures, is often helpful in detecting the part of the brain most involved in seizures.
　　　
　　　* Video-EEG long-term monitoring, often helps us to localize, or determine the part of the brain "responsible" for seizures. During video-EEG long-term monitoring, we simultaneously record the child's EEG (brain wave pattern) with a video recording of his behavior during seizures. Localizing the seizures, or finding out where they start in the brain, is essential when we think about surgery to control seizures. That is why recording several seizures is so important in the process of evaluation for epilepsy surgery.
　　　
　　　* CT scan and MRI help us identify structural problems in the brain which may be responsible for seizures, such as lesions, benign tumors or small areas of inflammation or malformation. Language, memory, concentration, motor, visual-spatial and other skills are assessed during neurodevelopmental testing, looking for areas of strength and weakness. Often parts of the brain severely affected by epilepsy do not work quite as well as other parts of the brain. Testing for subtle differences may further help us identify these "trouble spots".
　　　
　　　* PET scan ( a study of brain energy levels or metabolism) helps us identify areas of brain abnormality which may be linked with seizures. In infants and toddlers with uncontrolled infantile spasms, and in other children whose seizure origin is not well-defined by the procedures above, the information we gain from PET scans can be crucial in helping to define the "epileptic zone" prior to surgery.
　　　
　　　* Functional MRI is an exciting new diagnostic technique utilized in carefully selected cases. It allows us to identify areas of the brain which are activated during different "thinking tasks". Other sophisticated techniques to map brain function are utilized at our Comprehensive Epilepsy Center, depending on a child's age and capacity to cooperate during testing.
　　　　　
　　　　　　
　　　　　　　　
Why Need so Many Tests? 　　< back top >
　　　　
　　　Extensive evaluation is required to determine the source of the seizures; then, we must predict any major problems with speaking, understanding or other abilities if we remove the source, or part of the brain responsible for the seizures. Many seizures which appear to be generalized, or involve all of the brain at once, prove - through expert investigation - to actually begin in one small part of the brain, and can be improved or controlled through resective surgery. We carefully tailor our neurosurgical approach to (1) obtain maximum seizure control and (2) minimize any dysfunction or difficulties afterward. Our aim, always, is to improve quality of life.
　　　　
　　　All of the techniques discussed in the section above, on resective surgery, are approaches used for planning a neurosurgical approach to location-related epilepsies (epilepsies with one area of onset) in infants, children and adults. In the following part, surgical techniques that are unique to children are discussed.
　　　　　　
　　　
　　　　
How about the results of epilepsy surgery in children? 　　< back top >
　　　　
　　　Many patients are seizure-free after surgery; most have a great reduction in seizure frequency and severity. The improved seizure control allows children to maximize their developmental potential. The process of evaluation for epilepsy surgery is a long, careful one, to ensure that the neurosurgical approach, if chosen, is a safe and desirable option.
　　　　
　　　At The Shenzhen Children's Hospital Comprehensive Epilepsy Center, the management of severe epilepsies of early childhood includes recognition of cases which would benefit from neurosurgical approach. The capacity of the young, developing brain to re-organize allows pediatric epilepsy surgery to achieve its goal - control of seizures - with maximal preservation of abilities. For infants, children and young adults whose seizures have not been controlled by medications, neurosurgical intervention for intractable epilepsy is an exciting treatment possibility.