Seventy-five children, ages 5 months to 15 years, were treated for intractable seizures in the Neurosurgical Dept. of Washington University School of Medicine, St. Louis, MO, USA. The use of implantable arrays of epidural electrodes facilitated extraoperative electrocorticography (ECOG) and simultaneous video monitoring that provided localizing information prior to cortical excision in 53 patients. The pathological lesions were chronic encephalitis of Rasmussen (9), cortical sclerosis with infantile hemiplegia (7), mesial temporal sclerosis (6), extratemporal sclerosis (6), cortical dysplasia (4), tuberous sclerosis (3), porencephalic cyst (3), Sturge-Weber (3), polymicrogyria (2), heterotopia (2), occult vascular malformation (1), misc (7). Results were good in 32 (65%): 16 seizure free and 16 improved control after follow-up of 1-14 years. Gliomas were found in an additional 17 cases and were the most common single cause of intractable seizures; 82% were seizure free for more than 1 year (mean follow-up of 4.5 years) since surgery. [1]

COMMENT: With an increasing awareness of the adverse effects of antiepileptic drugs on learning and behavior in children (see Ped. Neur. Briefs 1987; 1:20) [2, 3] the need for alternative therapies becomes more apparent. The ketogenic and MCT diets could be used more frequently, metabolic causes requiring specific therapy (e.g. biotin, pyridoxine), though rare, should not be overlooked; and psychological factors especially important in the adolescent and young adult should be investigated and remedied. Dr. Goldring offers another alternative in surgical intervention which he believes to be a much under utilized therapeutic approach to intractable epilepsy in children. Although the emphasis and reliance on drugs in the management of seizures cannot be discounted, their promotion must not permit the neglect of preventive and alternative approaches to the child with seizures.