%0 Journal Article
%T Surgical Treatment of Pediatric Epileptic Encephalopathies
%A J. Fridley
%A G. Reddy
%A D. Curry
%A S. Agadi
%J Epilepsy Research and Treatment
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/720841
%X Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed. 1. Introduction Pediatric epileptic encephalopathies are a group of epileptiform disorders in which the epileptic processes themselves are believed to contribute to disturbances in neurologic function [1]. When this term was initially introduced, only a few conditions were included in this group: early myoclonic encephalopathy (EME)/Ohtahara syndrome, West syndrome, myoclonic epilepsy in infancy, Dravet syndrome, myoclonic status in nonprogressive epilepsy (MSNE), epilepsy with myoclonic astatic seizures (MAE), Lennox-Gastaut syndrome (LGS), and epileptic encephalopathy with continuous spike and wave during sleep (CSWS) including Landau-Kleffner syndrome [2]. In 2010 the International League against Epilepsy (ILAE) redefined this condition to include any epilepsy that can cause encephalopathy. In addition, focal or lesional epilepsy, both under-treated and particularly resistant to treatment, can also lead to global disturbance of brain function. Unfortunately many patients with these conditions are considered to have drug-resistant epilepsy (DRE), defined as failure of two tolerated, appropriately chosen antiepileptic medications [3]. Surgery, though uncommonly performed in patients with pediatric encephalopathy, can be a treatment option in carefully selected DRE patients [4, 5]. Surgical options include vagus nerve stimulation (VNS), corpus callosotomy (CC), lesionectomy, lobectomy, hemispherotomy/hemispherectomy, stereotactic thermal ablation, multiple subpial transection (MST), and deep brain stimulation (DBS). 2. Surgical Options in Epilepsy Management Placement of a VNS involves wrapping electrode leads around the left vagus nerve in the neck and connecting the electrode
%U http://www.hindawi.com/journals/ert/2013/720841/