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Evolving treatments for pediatric epilepsy

M. Michael Bercu

Traditional surgical procedures, such as localization and resection of epileptogenic foci and disconnection techniques, are currently used to treat drug-resistant focal epilepsy (DRFE) in children. Pediatric epilepsy surgery rates have increased from 0.85 surgeries per 1000 children with epilepsy in 1997 to 1.44 surgeries per 1000 children with epilepsy in 2009. In a prospective study of DRFE, 86% of children and 43% of adults were off antiepileptic drugs (AEDs) 10 years after surgery as compared with 0/93 nonsurgical controls. Reducing the life-long morbidity of childhood epilepsy can improve the quality of life of the children and their families and reduce healthcare costs. Many patients are not candidates for resection procedures when the seizure onset or network involves multiple cortical regions or eloquent cortex. Responsive neurostimulation (RNS System) therapy has been safely and successfully used in the adult population for the treatment of DRFE with one or two seizure foci.