Problemi speciali
Epilessia grave nel bambino: il ruolo del trattamento chirurgico
Severe epilepsy in children: the role of surgical treatment
Renzo Guerrini1, Flavio Giordano2, Lorenzo Genitori2, Carmen Barba3
1UOC di Neurologia Pediatrica, AOU Meyer e Università di Firenze; 2UOC di Neurochirurgia Pediatrica,
3UOC di Neurologia Pediatrica, AOU Meyer, Firenze
Aprile 2012 - pagg. 240 -243
Abstract
Epilepsy surgery represents an effective and safe treatment option in children with drug-resistant
seizures. The indications for epilepsy surgery are the following: a) pharmacoresistance;
b) severe epilepsy and possible disturbances in cognitive functions and behaviour; c) delineation
of a single, well delimited and surgically approachable epileptogenic zone. Etiology
and syndromes amenable to surgery are much more heterogeneous in children than in
adults. The rates of seizure freedom after surgery in children range from 60% to 80%. Early
surgical intervention may have a beneficial effect on cognitive performances and behaviour.
Factors predicting a favourable outcome in paediatric epilepsy include a single lesion on
MRI, especially in the temporal lobe and complete resection of the lesional area and the epileptogenic
zone. Children with drug-resistant seizures should be referred to paediatric epilepsy
centers with dedicated expertise in presurgical evaluation as soon as possible in order to
identify the best surgical candidates and define the optimal timing for surgery.
Parole chiave
Classificazione MeSH
Bibliografia
1. Guerrini R. Epilepsy in children. Lancet 2006;
367:499-524.
2. Berg AT, Vickrey BG, Testa FM, et al. How
long does it take for epilepsy to become intractable?
A prospective investigation. Ann Neurol
2006;60:73-9.
3. Obeid M, Wyllie E, Rahi AC, Mikati MA. Approach
to pediatric epilepsy surgery: State of the
art, Part I: General principles and presurgical
workup. Eur J Paediatr Neurol 2009;13:102-14.
4. Spencer S, Huh L. Outcomes of epilepsy surgery
in adults and children. Lancet Neurol 2008;
7:525-37.
5. Harvey AS, Cross JH, Shinnar S, Mathern BW;
ILAE Pediatric Epilepsy Surgery Survey Task
force. Defining the spectrum of international
practice in pediatric epilepsy surgery patients.
Epilepsia 2008;49:146-55.
6. Kwan P, Arzimanoglou A, Berg AT, et al. Definition
of drug resistant epilepsy: consensus proposal
by the ad hoc Task Force of the ILAE Commission
on Therapeutic Strategies. Epilepsia
2010;51:1069-77.
7. Cross JH, Jayakar P, Nordli D, et al. International
League against Epilepsy, Subcommission for
Paediatric Epilepsy Surgery; Commissions of
Neurosurgery and Paediatrics. Proposed criteria
for referral and evaluation of children for epilepsy
surgery: recommendations of the Subcommission
for Pediatric Epilepsy Surgery. Epilepsia
2006;47:952-9.
8. Freitag H, Tuxhorn I. Cognitive function in
preschool children after epilepsy surgery: rationale
for early intervention. Epilepsia 2005;46:
561-7.
9. Vasconcellos E, Wyllie E, Sullivan S, et al. Mental
retardation in pediatric candidates for epilepsy
surgery: the role of early seizure onset. Epilepsia
2001;42:268-74.
10. Benifla M, Sala F Jr, Jane J, et al. Neurosurgical
management of intractable rolandic epilepsy
in children: role of resection in eloquent cortex. J
Neurosurg Pediatr 2009;4:199-216.
11. Jansen FE, van Huffelen AC, Algra A, van
Nieuwenhuizen O. Epilepsy surgery in tuberous
sclerosis: a systematic review. Epilepsia 2007;48:
1477-84.
12. Jonas R, Asarnow RF, LoPresti C, et al. Surgery
for symptomatic infant-onset epileptic encephalopathy
with and without infantile spasms.
Neurology 2005;64:746-50.
13. Rosenfeld JV. The evolution of treatment for
hypothalamic hamartoma: a personal odyssey.
Neurosurg Focus 2011;30:E1.
Corrispondenza: r.guerrini@meyer.it