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Pediatric epilepsy surgery: the earlier the better

Epilepsy surgery is the only curative treatment currently available for focal lesional pharmacoresistant epilepsy. New antiepileptic drugs (AEDs), the ketogenic diet, or vagal nerve stimulation each lead to a worthwhile reduction of seizures in only 40-50% of patients and rarely achieve complete seizure freedom. In sharp contrast, long-term – five or more years complete seizure freedom rates of around 60% are reached following epilepsy surgery [1]. Although clinicians who take care of children with refractory epilepsy have been convinced of the beneficial effects of surgery for at least two decades [2], it was recently that a randomized controlled trial unequivocally proved the superiority of epilepsy surgery over continued medical treatment in pediatric surgical candidates [3]. Not only is surgery more effective, it is also less costly in the long term than medical treatment in children who are suitable for epilepsy surgery [4]. Surgical outcome depends on several factors, which include age, duration of epilepsy, results and concordance of presurgical investigations, type and lobe of surgery, completeness of resection, and type of pathology [2,5].