Developmental outcome after epilepsy surgery in infancy
Tobias Loddenkemper1, Katherine D Holland, Lisa D Stanford
1Department of Pediatric Neurology, Cleveland Clinic, Cleveland, OH 44195-5245, USA.
Insights
Epilepsy surgery in infants improved seizure control and developmental quotient (DQ). Preoperative DQ and younger age, especially with epileptic spasms, predicted greater DQ gains post-surgery.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Epilepsy Surgery Outcomes
Background:
- Epilepsy surgery in infants (<3 years) is complex.
- Assessing developmental impact is crucial for this age group.
Observation:
- Fifty infants (<18 years) underwent epilepsy surgery.
- Bayley Scales of Infant Development assessed neurodevelopment.
- Developmental quotient (DQ) was calculated.
Findings:
- Modest postoperative DQ improvement observed.
- Preoperative and postoperative DQ correlated well.
- Younger age and epileptic spasms associated with greater DQ increase.
Implications:
- Epilepsy surgery can positively impact infant development.
- Early surgical intervention may be beneficial.
- Preoperative developmental status is a key predictor of outcome.
Objectives:
Our goals were to determine the effect of epilepsy surgery in infants (<3 years of age) on development and describe factors associated with postoperative developmental outcome.
Methods:
We identified 50 infants among 251 consecutive pediatric patients (<18 years old) undergoing epilepsy surgery. Charts were reviewed for clinical data and neurodevelopmental testing with the Bayley Scales of Infant Development. A developmental quotient was calculated to compare scores of children at different ages.
Results:
Complete data were available on 24 of 50 infants. Surgeries included 14 hemispherectomies and 10 focal resections. Seventeen patients became seizure free; 5 patients had >90% seizure reduction, 1 had >50% seizure reduction, and 1 had no change. The developmental quotient indicated modest postoperative improvement of mental age. The preoperative and postoperative development quotients correlated well. Younger infants had a higher increase in developmental quotient after surgery. Patients with epileptic spasms were younger and had a lower developmental quotient at presentation, but increase in developmental quotient was higher in this subgroup.
Conclusions:
After surgery, seizure frequency and developmental quotient improved. Developmental status before surgery predicted developmental function after surgery. Patients who were operated on at younger age and with epileptic spasms showed the largest increase in developmental quotient after surgery.
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