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Catastrophic epilepsy in infants and children: identification of surgical candidates
1Section of Pediatric Epilepsy, Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Pediatric epilepsy surgery is considered for infants with medically intractable epilepsy. Careful assessment of risks versus benefits is crucial for cognitive development outcomes.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Neuroscience
Background:
- Catastrophic epilepsy in infants presents with high seizure frequency and developmental issues.
- Surgical candidacy requires medically intractable epilepsy, a localized epileptogenic zone, and low surgical risk.
- Preoperative MRI often reveals epileptogenic lesions like tumors or cortical malformations.
Purpose of the Study:
- To review the complex, age-related issues in assessing surgical risks and benefits for infants with catastrophic epilepsy.
- To discuss the potential impact of uncontrolled seizures and epilepsy surgery on cognitive development.
- To illustrate these considerations using two clinical cases.
Main Methods:
- Literature review focusing on pediatric epilepsy surgery in infants.
- Analysis of risk-benefit assessments for surgical candidates.
- Case study review of two infants undergoing evaluation for epilepsy surgery.
Main Results:
- Infants with catastrophic epilepsy often have identifiable epileptogenic lesions on MRI.
- Decision-making involves balancing seizure control against potential cognitive developmental impacts.
- Outcomes are influenced by the specific lesion, surgical approach, and postoperative management.
Conclusions:
- Epilepsy surgery can be a viable option for select infants with catastrophic, intractable epilepsy.
- Thorough preoperative evaluation is essential to optimize surgical candidacy and predict outcomes.
- Long-term neurodevelopmental monitoring is critical following surgery for pediatric epilepsy.
Abstract:
Some pediatric candidates for epilepsy surgery have epilepsy which is considered catastrophic because of a high seizure frequency, often many per day, in association with developmental stagnation or regression. Increasing numbers of infants with catastrophic epilepsy are being considered for surgical treatment, if they have the key elements of surgical candidacy including medically intractable epilepsy, a localized epileptogenic zone, and a low risk of new, unacceptable, postoperative neurologic deficits. Most of these infants have had low grade tumor, cortical development malformations, or other epileptogenic lesions visualized on preoperative MRI. The assessment of potential risks and benefits for surgery in these patients involves complex, age-related issues including the possible impact of uncontrolled seizures or surgery, on cognitive development. This review will address some of these issues in the context of two clinical cases.