Lessons From the Surgical Management of Epilepsy

The seizures that define epilepsy often aren't as bad to a child's overall health as thesocial debilitation that can come part and parcel with it, according to Colin M. Roberts, MD,pediatric neurologist at Oregon Health & Science University in Portland, Ore.

Many children with epilepsy are never able to control their episodes of seizure. Speaking ata Sunday plenary session at AAP's National Conference and Exhibition, Dr. Roberts showed the newtechnologies that make a surgical option for treatment of these children a safer possibility thanever before.

Surgery is, luckily, unnecessary for most children diagnosed with epilepsy. Of the 20,000 to40,000 diagnosed each year, over 60% may outgrow it. And about two thirds are able to be treatedusing pharmaceuticals.

But one third are medically intractable, unresponsive to whatever drug is tried. Many ofthese children have cortical dysplasia. Treatment options had been limited, since the sameimperfection that causes seizures makes drugs unresponsive.

New imaging technologies are allowing for a "discreet focus" to be found, isolating only the"epilectogenic zone." High-density EEGs can attach over a hundred scalp sensors on a single cap. MEG(magnetoencephalography) tests can help map functioning and misfunctioning areas. SPECT scans canmeasure the blood flow of a brain. And higher-powered MRIs, running at 3 Teslas instead of thestandard 1.5 Teslas, can probe deeper into the brain, revealing unseen secrets.

Roberts began the talk with a frank plea for more medical students to consider a career inthe child neurology field. Its numbers are shrinking, he said, and as a result there often aren'tenough MDs across the country to perform the clinical trials needed to learn more aboutconditions.