A consecutive, retrospective analysis of seizure control and quality of life was performed in 83 patients who underwent epilepsy surgery at Children's Hospital of Wisconsin, Milwaukee, WI. The average age at surgery was 10 years (range <1 year to 21 years). Surgical procedures were extratemporal focal resections (39), temporal lobectomies (19), hemispherectomies (21), and corpus callosotomies (4). Seizure outcomes were generally favorable with 68.7% class I outcome (no seizures); 12% class II (3 seizures or less per year); 19.3% class III (>3 seizures per year). Seizure freedom was highest following temporal lobectomies (84.2%) and hemispherectomies (76.2%). Hemispherectomy was more effective than multilobar resections. Cortical dysplasia cases did less well with a 57.5% seizure control. Infants had the lowest seizure-freedom rate at 50%, attributable to frequency of multilobar resections for cortical dysplasia. Quality of life paralleled seizure outcome. Absence of defined lesion on MRI and young age should noi prevent surgical evaluation of children with intractable epilepsy. [1]

COMMENT. The authors conclude that surgery for intractable epilepsy in children is superior to continued trials of antiepileptic medications. An earlier age of intervention is important since epilepsy in the developing brain may cause more permanent damage to brain circuits. Similar results were reported from the Cleveland Clinic with seizure-free outcome in 69% of adolescents, 68% children, and 60% of infants. [2]