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Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
Developmental assessment-based surgical intervention for intractable epilepsies in infants and young children
T Matsuzaka1, H Baba, A Matsuo
1Department of Pediatrics, Nagasaki University School of Medicine, Sakamoto, Japan. neuro@net.nagasaki-u.ac.jp
Insights
For infants and young children with intractable epilepsy, early surgical intervention is key. Prompt surgery after detecting developmental quotient (DQ) decline minimizes long-term cognitive deficits.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
Background:
- Medically intractable epilepsies in infants and young children pose significant risks for developmental deficits.
- Determining the optimal timing for surgical intervention is crucial for mitigating these risks.
Observation:
- Developmental quotients (DQs) in children with intractable epilepsy tend to decrease over time, particularly with persistent frequent seizures.
- Periodic developmental assessments can identify DQ decline as early as 5 months after seizure onset.
Findings:
- Surgical intervention before significant DQ reduction resulted in normal postoperative DQ levels.
- Timely surgery (within 7 months of frequent seizure onset) was associated with better developmental outcomes.
- Delayed surgery (≥17 months) correlated with developmental delays, with incomplete DQ recovery observed even with early intervention after DQ decline.
Implications:
- Implementing regular developmental assessments upon the occurrence of frequent seizures is recommended.
- Surgical intervention for intractable epilepsy should be considered promptly upon recognizing any decline in DQ to optimize neurodevelopmental outcomes.
Purpose:
To define the most appropriate time for surgery for medically intractable epilepsies in infants and young children.
Methods:
First we examined retrospectively the changes in developmental quotients (DQs) during the clinical course and the clinical factors affecting the DQ in 39 consecutive patients younger than 15 years, who underwent surgical treatment for intractable epilepsy. Second, we examined prospectively five new patients for early detection of developmental arrest or regression by periodic developmental assessments and whether this could lead to early surgical intervention, eventually resulting in minimal developmental defects.
Results:
Retrospective studies revealed that the DQ progressively decreased with age and that the reduction of DQ was related to continuing frequent seizures in many patients. The prospective studies demonstrated that periodic developmental assessments could detect the reduction of DQ at 5 months or later after onset of frequent seizures in three patients. In two other patients, operations were performed before reduction of DQs, and their postoperative DQ levels were normal. The post-operative recovery of DQ was complete in one patient whose operation was performed 3 months after reduction of DQ, whereas it was incomplete in two others whose operations were carried out at 12 and 14 months after reduction, respectively. Furthermore, three patients with normal developmental outcome had shorter periods between the onset of frequent seizures and the operation (< or = 7 months) than those of two patients with developmental delay (> or = 17 months).
Conclusions:
To minimize the developmental defects, periodic developmental assessments should be initiated when frequent seizures have occurred, and surgery should be considered as soon as possible when DQ reduction is recognized.
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