Cortical resection for children with epilepsy: perspectives in pediatrics

Article Abstract:

Cortical resection (surgery on the brain) for epilepsy has been increasingly performed since the 1960s, and has allowed many children to become seizure-free and have a more normal development. This is a significant improvement, as adults with chronic epilepsy often have problems such as dependency, poor self-esteem, and vocational disability. Surgery may also free a child or adult from chronic use of anti-epileptic medication. This article reviews the principles and practice of surgical modification of the brain. Temporal lobectomy (removal or modification of the temporal lobe) is the most frequent surgery for epilepsy. Patients in this group usually have complex partial seizures, characterized by changes in behavior, loss of consciousness, and performance of automatic movements, but seldom convulsions. Most often, a structural brain lesion can be located, and magnetic resonance imaging is a preferred diagnostic method. Epileptic children are evaluated for appropriateness of surgical treatment based on the lack of responsiveness to all major anti-epileptic medications; degree of disability due to seizures; and lack of realistic probability of spontaneous remission. The presurgical neurophysiologic evaluation varies, depending on the complexity of the seizure condition; this is discussed. Several types of temporal lobe surgery are possible, depending on lobe involvement. Complications include visual field defects, which are most often asymptomatic, dysphasia (speech impairment), and memory loss, but most children who become seizure-free usually have improved, rather than diminished, school performance. After surgery, 57 to 100 percent of patients either have seizures eliminated or have them rarely, depending on the group studied. Surgery on other lobes of the brain is more common in very young children, and the evaluations and outcome for this type of surgery is discussed. Hemispherectomy, removal of part or all of one side of the brain, is performed in patients with debilitating, frequent, intractable seizures caused by extensive lesions. The medical indications and procedures for this are discussed. Early referral of any child with frequent seizures to a medical center specializing in epilepsy surgery is important to optimize the child's psychosocial maturation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Brain, Brain surgery, Epilepsy in children, Pediatric epilepsy

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Esophageal motility in children with Hirschsprung's disease

Article Abstract:

Hirschsprung's disease is characterized by chronic constipation, abdominal distention, and fecal impaction, due to megacolon (dilated colon) caused by lack of development of the nerve network that regulates intestinal activity. It is uncertain whether the disease may directly or indirectly affect intestinal activity above the colon, but children with the disease tend to have more severe gastrointestinal dysfunction such as anorexia and failure to thrive compared with children with megacolon and constipation from other causes. Esophageal motility was evaluated in 12 children with Hirschsprung's disease, eight children with idiopathic (cause unknown) megacolon, and 10 children without gastrointestinal problems, to determine if Hirschsprung's disease alters motor activity in other areas of the digestive tract besides the colon. The strength of the waves of muscle contraction was significantly higher in children with Hirschsprung's disease compared with the other two groups. These children also had more frequent abnormal muscle responses to swallowing, such as double peaks of muscle contraction. Surgical treatment of the colon in children with Hirschsprung's disease resulted in normalization of the strength of muscle contraction, but abnormal motor responses remained. No difference in esophageal motility could be found between healthy children and those with idiopathic megacolon. The results suggest that the neuromuscular defects in Hirschsprung's disease may not be confined to the colon, but may extend to other areas of the digestive tract as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Esophagus, Gastrointestinal system, Gastrointestinal motility, Hirschsprung's disease, Diffuse esophageal spasm

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