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Epilepsy surgery in infancy. A review of four cases
Greg Olavarria1, Joseph A Petronio
1Department of Neurosurgery, Children's Memorial Hospital, Chicago, Ill 60614, USA. golavarr@childrensmemorial.org
Insights
Early surgical intervention for intractable pediatric seizures can lead to dramatic recovery. Resection of the epileptogenic focus in infants significantly improved seizure control, with some becoming seizure-free.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Intractable seizures in infants often present significant challenges to management.
- Surgical resection of the epileptogenic zone is a recognized treatment for refractory epilepsy.
- Limited data exists on early surgical intervention in very young infants.
Observation:
- This study reviewed 4 infants (5-9 months old) with severe, intractable seizures unresponsive to anticonvulsants.
- All infants underwent pre-operative EEG and MRI; 2 had PET imaging.
- Surgical procedures included temporal resection for glioma and cortical resections for malformations/dysplasia.
Findings:
- All 4 infants demonstrated improvement in seizure control post-operatively.
- Two infants achieved complete seizure freedom off all anti-epileptic medications.
- Surgical intervention led to significant positive outcomes in this cohort.
Implications:
- Early surgical intervention should be strongly considered for infants with severe, intractable epilepsy.
- Prompt treatment can lead to dramatic recovery and improved long-term neurological outcomes.
- This approach offers a promising alternative for managing pediatric refractory seizures.
Abstract:
It has been demonstrated that intractable seizures in children can be eliminated or become more responsive to anticonvulsant medication after surgical resection of the epileptogenic focus or dysfunctional hemisphere. We describe our surgical experience with 4 infants treated at Children's Healthcare of Atlanta Egleston Hospital between 1994 and 2002. All infants, ranging in age from 5 to 9 months, presented with severe seizure disorders and failed trials of anticonvulsants. All had preoperative EEG monitoring and MRI studies; 2 had PET functional imaging. One infant underwent a temporal resection for a low-grade glioma. The rest had cortical resections for malformations and dysplasia. All had improvement, with 2 infants free of seizures off medication. We argue for early intervention in severe cases, as the potential for recovery can be dramatic.