Aug 2026· Journal of Surgical Research· Vol 9, pp. 244 - 255· 0 citations· 48 references
Medicine
TL;DR
The available evidence supports earlier referral for surgical evaluation in children with DRE and suggests that prompt intervention may preserve neurodevelopment, improve long-term functional outcomes, and maximize quality of life.
Abstract
Meckel’s Pediatric drug-resistant epilepsy (DRE) is a significant neurological disorder that develops when seizures persist despite treatment with two appropriately selected antiseizure medications. Although only a subset of children with epilepsy develops DRE, prolonged uncontrolled seizures during childhood can result in irreversible cognitive, behavioral, and developmental impairment. Over time, growing evidence has demonstrated that epilepsy surgery is an effective treatment for appropriately selected patients and that earlier surgical intervention is associated with improved relief from seizures and long-term neurodevelopmental outcomes. This review examines the mechanisms underlying pharmaco-resistance, including network reorganization, neuroinflammation, blood-brain barrier dysfunction, and structural abnormalities that contribute to epileptogenesis. Common surgically remediable causes of pediatric DRE, including focal cortical dysplasia, mesial temporal sclerosis, tuberous sclerosis complex, hemimegaloencephaly, and tumor-associated epilepsy, are discussed along with current surgical approaches, including resective, disconnective, and minimally invasive procedures. The evidence comparing early versus delayed surgical intervention is reviewed with emphasis on seizure control, cognitive development, language, behavior, and quality of life. Finally, this review highlights persistent barriers to timely surgical referral, including socioeconomic, geographic, and racial disparities, while exploring emerging advances in neuroimaging, artificial intelligence-assisted lesion detection, and imaging biomarkers that may improve early diagnosis and patient selection. Collectively, the available evidence supports earlier referral for surgical evaluation in children with DRE and suggests that prompt intervention may preserve neurodevelopment, improve long-term functional outcomes, and maximize quality of life.
Abstract Background Drug-resistant epilepsy (DRE) remains a major cause of neurological morbidity worldwide, affecting approximately one-third of patients with epilepsy despite advances in antiseizure medications. Persistent seizures are associated with increased mortality, cognitive decline, psychosocial impairment, and reduced quality of life. Surgical intervention represents the most effective treatment for carefully selected patients; however, substantial delays in referral and underutilization of epilepsy surgery continue to be reported globally. This study is done to provide a contemporary evidence-based review of patient selection, presurgical evaluation, surgical decision-making, and outcomes across the spectrum of epilepsy surgery modalities. Methods A narrative review of the current literature was performed, focusing on the definition of DRE, indications for surgical referral, presurgical investigations, resective and disconnective surgical procedures, minimally invasive techniques, and neuromodulation strategies. Emphasis was placed on practical clinical decision-making and contemporary developments influencing patient selection. Results Successful epilepsy surgery depends primarily on accurate localization of the epileptogenic zone and careful multidisciplinary evaluation. Temporal lobe epilepsy remains the most favorable indication for resective surgery, while advances in stereoelectroencephalography, neuroimaging, laser interstitial thermal therapy, and neuromodulation have expanded treatment options for patients previously considered unsuitable for surgery. Contemporary presurgical assessment integrates clinical semiology, prolonged video-electroencephalographic monitoring, high-resolution magnetic resonance imaging, functional imaging, and neuropsychological evaluation to optimize patient selection and maximize postoperative seizure control. Conclusion Appropriate patient selection remains the cornerstone of successful epilepsy surgery. Continued advances in imaging, electrophysiology, minimally invasive techniques, and neuromodulation are transforming the management of DRE and facilitating increasingly individualized treatment strategies.
Vartika Gupta, Pankaj Gupta· Asian Journal of Neurosurger...· 0 citations
Current and emerging pharmacotherapeutic options for selected representative pediatric focal epilepsies are summarized using a syndrome- and localization-oriented approach, highlighting conventional antiseizure medications, newer agents, and investigational or repurposed treatments.
L. Perilli, G. Dell’Isola, Pietro Ferrara et al.· Expert Opinion on Pharmacoth...· 0 citations
This review examines the evolving landscape of pediatric OLE, highlighting the shift from syndromic to etiological classification and management strategies and the need to monitor cognitive comorbidities and syndrome evolution.
Preeti Srivastava, D. Nag, Shikha Swaroop et al.· World Journal of Clinical Pe...· 0 citations
Delays from DRE diagnosis were independently associated with reduced seizure freedom, supporting presurgical evaluation within 1 year as an evidence-based quality benchmark, and DRE-to-evaluation interval, not total epilepsy duration, predicted outcomes.
Debopam Samanta, A. Caraway, Andrew T. Knox et al.· Neurology Clinical Practice· 0 citations
Thalamic neuromodulation using DBS and RNS was safe and well tolerated in pediatric patients with DRE, including multifocal and generalized seizure onsets, with a trend toward greater benefit in the DBS group.
Dominic Nistal, Benjamin D. Edmonds, Adriel Barrios-Anderson et al.· Journal of Neurosurgery: Ped...· 0 citations
OBJECTIVE
This study was undertaken to assess cenobamate (CNB) effectiveness, tolerability, and dosing in pediatric developmental and epileptic encephalopathies (DEEs), testing prespecified hypotheses on response by syndrome, etiology, electroencephalographic pattern, seizure type, CNB dose (mg/kg/day), and concomitant medication.
METHODS
A retrospective multicenter cohort of children (≤18 years old) with DEEs were treated with CNB at 17 Spanish hospitals. Primary outcomes were retention, response (≥50% reduction), and seizure freedom at 3, 6, and 12 months. Mixed-effects logistic and ordinal models were adjusted for age, syndrome, etiology, seizure type, and concomitant medication.
RESULTS
Among 152 children (median age = 12 years), 27.6% had Lennox-Gastaut syndrome (LGS) and 58.6% unspecified DEE, with a median of 9 prior antiseizure medications. Retention was 88%, 90%, and 93% and responder rates 64%, 73%, and 79% at 3, 6, and 12 months; seizure freedom was 8%, 12%, and 18% (evaluable n = 152, 105, and 57 at 3, 6, and 12 months, respectively). LGS and other DEEs reached identical 12-month responder rates (both 79%), whereas Dravet syndrome showed limited sustained benefit. By etiology, structural cases had the highest 12-month responder rate (93% vs. 68% in nonstructural, p = .04), but no etiology was independently associated with response. By seizure type, responder rates were highest for tonic (81%) and bilateral tonic-clonic (76%) and lowest for absences (54%, adjusted odds ratio [OR] = .43, p = .032). Treatment-emergent seizure worsening occurred in 10.5%. Sodium channel blockers were the main risk factor for adverse events (OR = 2.10); 10.5% discontinued CNB due to adverse events.
SIGNIFICANCE
CNB was associated with sustained effectiveness and acceptable tolerability across pediatric DEEs. Slow weight-based titration and proactive simplification of sodium channel blockers and clobazam may optimize benefit-risk.
Ángel Aledo-Serrano, Adrián Valls-Carbó, E. González-Alguacil et al.· Epilepsia· 0 citations
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