Abstract
Because epilepsy in children can lead to untoward developmental consequences, the key notion is that children with therapy-resistant epilepsy should be diagnosed early and referred to a pediatric epilepsy center so that they may receive a comprehensive evaluation by an interdisciplinary team experienced in treating this disorder. The diagnosis of therapy-resistant epilepsy should be entertained after the child has failed two antiepileptic drugs. Of all children diagnosed with treatment-resistant epilepsy, up to 33% may be eligible for surgical treatment. Within the spectrum of therapy-resistant epilepsy, children with structural anomalies on neuroimaging are the best candidates for curative surgical therapy by resecting the epileptogenic region. Palliative procedures, such as vagal nerve stimulation and corpus callosotomy, are reserved for patients with severe refractory seizures who are not candidates for curative surgery. Importantly, early surgical intervention in children with treatment-resistant epilepsy can lead to better seizure-free outcomes, improved developmental indices, and enhanced quality of life. © 2012 Elsevier B.V.