Four children with intractable neonatal-onset seizures treated successfully by hemispherectomy at 1 1/2-5 years of age are reported from UCLA School of Medicine, Los Angeles, California. Positron emission tomography (PET) with fluoro-D-glucose provided accurate localization of seizure foci whereas CT and MRI were either normal or showed mild generalized cerebral atrophy. The report illustrates the important role of PET in the evaluation of children with intractable epilepsy of neonatal onset. [1]
COMMENT. The criteria for hemispherectomy were as follows: 1. Intractable unilateral seizures with diffuse epileptic activity in the affected hemisphere. 2. Persistent neurologic deficit on the contralateral side. 3. Malfunction of the affected hemisphere and intact function of the opposite hemisphere as tested by interictal EEGs, evoked potentials, thiopental test, and PET. At UCLA the results of surgery are impressive: the patients were seizure-free for periods up to 1 1/2 years and 3 patients were off all anticonvulsants. The surgical approach to treatment of refractory seizures appears superior to the conservative method with potentially toxic anticonvulsant drugs. The authors are to be complemented for their aggressive approach and search for alternate forms of early treatment.