Catastrophic epilepsy in infants and children: identification of surgical candidates

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.