Pediatric
epilepsy has a wide variety of etiology and severity. A recent epidemiological study suggested that surgery might be indicated in as many as 5% of the pediatric
epilepsy population. Now, we know that effective
epilepsy surgery can result in seizure freedom and improvement of psychomotor development. Seizure control is the most effective way to improve patients neurologically and psychologically. In this review, we look over the recent evidence related to pediatric
epilepsy surgery, and try to establish the optimal surgical timing for patients with
intractable epilepsy. Appropriate surgical timing depends on the etiology and natural history of the
epilepsy to be treated. The most common etiology of pediatric
intractable epilepsy patients is malformation of cortical development (MCD) and early surgery is recommended for them. Patients operated on earlier than 12 months of age tended to improve their psychomotor development compared to those operated on later. Recent progress in neuroimaging and electrophysiological studies provide the possibility of very early diagnosis and comprehensive surgical management even at an age before 12 months.
Epilepsy surgery is the only
solution for patients with MCD or other congenital diseases associated with
intractable epilepsy, therefore physicians should aim at an early and precise diagnosis and predicting the future damage, consider a surgical
solution within an optimal timing.