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Approximately 60% of all patients with epilepsy suffer from focal epilepsy syndromes. In approximately 15% of these patients, the seizures are not adequately controlled with anticonvulsive drugs, and such poorly controlled patients are potential candidates for surgical treatment and majority are children. Epilepsy surgery in children, who have been carefully chosen, can result in either seizure freedom or a marked (>90%) reduction in seizures in approximately two-third of children with intractable seizures.
In the presurgical evaluation approach identifying the location and extent of the epileptogenic zone with a high degree of confidence is critical for successful surgery.. Early surgery improves the quality of life and cognitive and developmental outcome of the child. Surgically treatable epilepsies in children should be identified early and include temporal lobe epilepsy with focal lesions, lesional extratemporal epilepsies, hemispherical epilepsies, and gelastic epilepsy with hypothalamic hamartoma, and can be treated by resective or disconnection surgery.
Palliative procedures include corpus callosotomy and vagal nerve stimulation for children with diffuse and multifocal epilepsies, who are not candidates for resective surgery. For children with “surgically remedial epilepsy,” surgery should be offered as a procedure of choice rather than as a treatment of last resort whenever is available.In The middleeast the biggest challenge is to have a well trained team of pediatric neurologist, pediatric epileptiologist with adequate training in epilepsy surgery along with highly qualified and trained epilepsy surgeon.