Head, Section of Pediatric Epilepsy, The Cleveland Clinic Foundation, S51, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
Some pediatric candidates for epilepsy surgery have epilepsy which is considered catastrophic because of a high seizure frequency, often many per day, in association with developmental stagnation or regression. Increasing numbers of infants with catastrophic epilepsy are being considered for surgical treatment, if they have the key elements of surgical candidacy including medically intractable epilepsy, a localized epileptogenic zone, and a low risk of new, unacceptable, postoperative neurologic deficits. Most of these infants have had low grade tumor, cortical development malformations, or other epileptogenic lesions visualized on preoperative MRI. The assessment of potential risks and benefits for surgery in these patients involves complex, age-related issues including the possible impact of uncontrolled seizures or surgery, on cognitive development. This review will address some of these issues in the context of two clinical cases.