Selecting the right paediatric patient for epilepsy surgery

Even though epilepsy is commonly referred to as one disease it would be much more accurate to refer to the epilepsies, as the term describes a wide group of conditions with the common characteristic of recurrent epileptic seizures, but many different underlying causes and consequently differing underlying pathophysiologies. One group within these conditions are the structural epilepsies, epilepsies in which there is a structural brain abnormality responsible for the seizures. Even though this again is a heterogeneous group, structural epilepsies do share some common characteristics not least that they very often prove drug resistant, failing two or more appropriately chosen and dosed antiepileptic drugs as defined by the International League Against Epilepsy (ILAE). We know that patients failing the first two antiepileptic drugs (AEDs) have fewer than 5% chances of responding to a third or fourth medication. Unilateral structural lesions however may be amenable to resection giving these patients a chance of cure. Thus it is crucial that this treatment is considered.