Children with medically resistant epilepsy are being increasingly considered for resectional surgery. Most children have extratemporal seizures usually related to developmental lesions including cortical dysplasia. Despite advances in magnetic resonance imaging (MRI) technology, many children do not reveal structural abnormalities. Functional imaging using single photon emission computed tomography (SPECT), positron emission tomography (PET), and magnetic resonance spectroscopy assist in defining the epileptogenic region, especially in nonlesional cases. Subdural EEG monitoring provides definitive localizing information and also facilitates mapping of motor language cortex. More than 80% of children undergoing excisional procedures achieve complete seizure control or substantial reduction in frequency with consequent improvement in psychosocial and rehabilitative status. Potential candidates should be considered as early as possible for epilepsy surgery.
