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Neurobiologic Considerations in Early Surgery for Epilepsy

Comprehensive Epilepsy Center and Department of Neurology, Miami Children's Hospital

Bonnie Levin

Division of Neuropsychology and Department of Neurology, University of Miami School of Medicine, Miami, FL

Prasanna Jayakar, MD, PhD

Comprehensive Epilepsy Center and Department of Neurology, Miami Children's Hospital

Trevor J. Resnick, MD

Comprehensive Epilepsy Center and Department of Neurology, Miami Children's Hospital

Children with well-localized medically resistant seizures are often referred for surgical therapy. In young children, at least three maturational issues playa significant role in the selection process and long-term outcome. First, the early years are a time of exceptionally rapid brain development leading to dynamic changes in the electroencephalogram and the clinical expression of seizures. Many early-onset seizure presentations are also associated with catastrophic outcomes, developmental arrest, or regression. Second, the immature limbic system may be vulnerable to stresses operating in early life, although the consequences may not become apparent for many years. Third, in comparison to the adult, the child's nervous system typically exhibits superior functional recovery after lesioning, but the process of sparing and recovery is often incomplete. An understanding of how these neurobiologic factors influence developmental outcome will ultimately lead to greater selectivity of candidates for early surgery and to improved long-term prognosis. (J Child Neurol 1994;9(Suppl):2S42-2S49).

Journal of Child Neurology, Vol. 9, No. 2 Suppl, 2S42-2S49 (1994)
DOI: 10.1177/0883073894009002071


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