Surgical treatment of late-onset post-traumatic partial seizures in a child.

INTRODUCTION: Although post-traumatic epilepsy accounts for a small number of epileptic patients, it should not be underestimated since it primarily affects children and young adults and can result in psychosocial disability and death. CASE REPORT: We present the case of a 14-year-old girl referred to us because of refractory partial seizures. The patient had experienced a head trauma at the age of 6 months requiring surgical treatment due to a large right fronto-temporo-parietal extradural hematoma. She was discharged on phenytoin prophylactically. At the age of 4 she had her first partial seizure, characterized by left arm and leg tonic-clonic movements. Her physical examination revealed a subtle left brachiocrural hemiparesis and developmental delay. Several antiepileptic drugs were tried and seizure control was not achieved. They were occurring 8-10 times per day. The proposed surgical treatment was based on the consistent seizure semiology and on the affected area as identified by MRI and visible macroscopically to the neurosurgeon. At 9 years follow-up the patient is seizure free. Her motor skills are adequate for living a normal life.
CONCLUSION: We emphasize that selected patients may benefit from surgical treatment when epilepsy results from a trauma.