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Outcome of epilepsy surgery in the first three years of life
T Sugimoto1, H Otsubo, P A Hwang
1Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Epilepsy surgery in children aged 0-3 years showed varied outcomes. Hemispherectomies yielded excellent seizure control, while focal cortical dysplasia cases had less favorable results.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Epilepsy surgery in early childhood is complex.
- Understanding surgical outcomes is crucial for treatment planning.
Purpose of the Study:
- To analyze the surgical outcomes of epilepsy surgery in children aged 0-3 years.
- To compare outcomes based on surgical procedure and underlying pathology.
Main Methods:
- Retrospective review of 23 children (ages 0-3) who underwent epilepsy surgery between 1991-1996.
- Analysis of seizure types, pathologies, surgical procedures (focal cortical resections, hemispherectomies), and outcomes using Engel's criteria.
Main Results:
- Partial seizures were most common (20/23).
- Mean age at seizure onset was 4.7 months, and at surgery was 15.3 months.
- 12 patients achieved Engel class I outcome; hemispherectomies showed excellent results compared to focal resections.
Conclusions:
- Seizure outcomes were less favorable in infants with focal cortical dysplasia (FCD) compared to Sturge-Weber syndrome (SWS) and low-grade glioma (LGG).
- Hemispherectomy demonstrated superior seizure control in this pediatric cohort.
Purpose:
We analyzed our experience over a 6-year period with early-childhood patients who had undergone epilepsy surgery, and investigated the surgical outcomes.
Method:
We reviewed the medical records of 23 children, ages 0-3 years, who underwent epilepsy surgery between 1991 and 1996.
Results:
Twenty children had partial seizures; two had infantile spasms; and one had generalized tonic-clonic seizures at onset. The mean age at onset of seizures was 4.7 months, and the mean age at time of surgery was 15.3 months. A total of 32 operations (21 focal cortical resections and 11 hemispherectomies) was performed. Five of 12 children with seizures secondary to a neuronal migration disorder had reoperations, including three who ultimately underwent complete hemispherectomy. The pathology consisted of hemimegalencephaly in three patients, focal cortical dysplasia (FCD) in eight, tuberous sclerosis in one, Sturge-Weber syndrome (SWS) in five, infarction in two, low-grade glioma (LGG) in three, and post-herpes simplex virus encephalitis (HSE) in one. The follow-up period ranged from 1 to 6.5 years (mean, 3.2 years) from patients' last operation. The seizure outcome according to Engel's criteria was class I in 12 patients, class II in three, class III in six and class IV in two.
Conclusions:
Seizure outcomes after surgery were less favorable in infants with FCD than in those with SWS and LGG. Seizure outcome for the patients with hemispherectomies was excellent, compared with those who had focal cortical resections.