Pharmacologically Intractable Epilepsy In Children

Abstract and Introduction

Abstract

It is important to correctly diagnose medically intractable epilepsy in children and to identify those children whose medically refractory, localization-related seizures may be surgically remediable as soon as possible to optimize the surgical outcome. In this paper the authors review the definition of medically intractable seizures and discuss the various causes and risk factors for this disorder in children. They also outline the presurgical diagnostic evaluation process for pharmacologically intractable epilepsy in children who may be candidates for surgical treatment of localization-related seizures. The treatment of children with medically intractable epilepsy is both challenging and rewarding. Surgery has the potential of altering the natural history of epilepsy by improving or eliminating seizures in carefully selected patients.

Introduction

Recurrent, spontaneous, unprovoked seizures—that is, those associated with epilepsy—affect 3–5% of the population worldwide.^[32,55] The incidence of epilepsy in childhood varies among different age groups and geographic locations. Data from a variety of epidemiological studies have indicated that recurrent unprovoked seizures occur in 1–2% of children, with the highest incidence in the 1st year of life. The incidence of epilepsy plateaus in early childhood and decreases after 10 years of age.^[17,31,33] Approximately 10–40% of children with epilepsy will continue to have seizures despite optimal medical management with AEDs.^{[13,16,25,57]} It is important to be aggressive in the diagnosis and treatment of medically refractory epilepsy in children given the adverse effect of recurrent seizures on early brain development, learning, and memory. Moreover, young children with this intractable disorder may be better candidates for aggressive surgical treatment because of the increased neuroplasticity of the developing brain.^[19,23,71] Other treatment modalities, such as a ketogenic diet and vagus nerve stimulation, can be considered in children who are not good candidates for epilepsy surgery.^{[34,41,44,54]} In this paper we review the definition of medically refractory epilepsy and consider the evaluation of children with medically intractable seizures for surgery.