A method for surgical management of focal epilepsy, especially as it relates to children

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Abstract
All surgical manipulation is carried out under general, rather than local, anesthesia; the sensorimotor region is readily identified in the anesthetized patient by recording cortical sensory evoked responses and the epileptogenic focus is localized by extraoperative electrocorticography via indwelling epidural electrode arrays, localization deriving from recordings made during spontaneously occurring clinical seizures. In some instances, recording of sensory evoked responses is the only means of sensorimotor localization in both the awake and anesthetized patient. Spontaneous and electrically induced EEG seizure activity may provide false localization of the focus, the correct localization requiring recordings made during spontaneous clinical seizures. The outcome of surgery and the various epileptogenic lesions encountered were described. A good result was achieved in 61% of patients followed 1-10 yr. When the results obtained in children were analyzed alone, 70% had benefited from surgery.