Epilepsy surgery in children: why, when and how?

Epilepsy surgery is safe and effective treatment in children who fail to respond to antiepileptic medications. After failure of two appropriate antiepileptic medications, chances that the child will become seizure free with more or different medications is <5%, and she should be diagnosed with "refractory epilepsy". A consideration for surgical candidacy should be given to all children who fulfill the definition of refractory epilepsy. In appropriately selected children, epilepsy surgery offers a high chance of seizure freedom without incurring any new post-operative neurological deficits. No age is bar to epilepsy surgery. Even infants can safely have epilepsy surgery if they are surgical candidates. For most children, who are surgical candidates, a good history and physical examination, video EEG evaluation, and a high quality brain MRI are sufficient to make surgical decision. These tools are increasingly available all over the world. Better education of families, Pediatricians, Pediatric Neurologists and community care-givers is necessary to salvage children early from mortality and morbidity of untreated, sometimes life long, epilepsy.