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Surgery for epilepsy is not new, it has been performed for over 100 years. However, there has been a reluctance to consider young children for surgery other than in exceptional circumstances, owing in part to the invasive nature of the presurgical evaluation. Recent advances in investigative techniques have allowed identification of candidates early in their natural history avoiding the long term consequences of chronic epilepsy. Based on a prevalence rate of 3–6/1000 and current population figures of 60 000 children with epilepsy, about 15 000 are unresponsive to anticonvulsant medication, and of these as many as 3000 might benefit from surgery. There are currently six centres in the UK offering surgery to children. Of these, Great Ormond Street in London operates exclusively on children (30 cases/year), although for each child who comes to surgery it is likely four have been evaluated.
The case for early surgery
Most adults coming to an epilepsy surgery programme have had a history of seizures since childhood,1 the consequences of which are severalfold. Studies of selected groups of children with ongoing seizures suggest that severe epilepsy is associated with cognitive decline2 and that early cessation of seizures is associated with better developmental outcome.3 The psychological consequences of recurrent seizures through school and teenage years are also apparent, both to the individual and the community.4 In addition, recurrent epileptic seizures are not without risk to the individual, both with regard to self injury during a seizure and the risk of sudden death.5 With advances in neurosurgical and neuroanaesthetic techniques, morbidity from planned neurosurgical procedures is now low. In addition, postoperative outcome of seizure control in studies performed to date in children are similar to those in adults.6 There is consequently no justification in conducting a “wait and see” policy rather than referral in children with epilepsy, particularly …