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Focal resection for malignant partial seizures in infancy
M S Duchowny1, T J Resnick, L A Alvarez
1Comprehensive Epilepsy Center, Miami, FL 33155.
Insights
Excisional surgery for drug-resistant epilepsy in infants is safe and effective. Surgical intervention in infants with medically uncontrolled malignant partial seizures can lead to seizure freedom or significant reduction, improving long-term outcomes.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Neurology
- Epilepsy Surgery
Background:
- Limited data exists on excisional surgery for drug-resistant epilepsy in infants.
- Malignant partial seizures in infants can lead to developmental deterioration.
- Standard antiepileptic drug (AED) therapies are often ineffective and toxic in this population.
Observation:
- Five infants under one year of age with medically refractory epilepsy underwent surgical evaluation.
- Patients experienced frequent daily seizures despite maximal AED therapy at therapeutic levels.
- Significant medication toxicity was observed in all participants.
Findings:
- Complete resection of epileptic foci in three infants resulted in complete seizure freedom.
- Partial resection in two infants led to a significant reduction in seizure frequency.
- No significant neurological deficits or developmental compromise were observed post-surgery.
Implications:
- Excisional surgery is a safe and viable option for selected infants with medically uncontrolled malignant partial seizures.
- Early surgical intervention may significantly improve long-term seizure control and developmental trajectories.
- Referral to specialized pediatric epilepsy centers is recommended for surgical evaluation in these complex cases.
Abstract:
There is little experience with excisional surgery for drug-resistant partial seizures in very young patients. We describe our experience with 5 infants under 1 year of age with malignant partial seizures and deteriorating developmental status. All were experiencing frequent daily seizures that did not respond to 1st-line antiepileptic medications at high therapeutic serum levels and considerable medication toxicity. Three infants had complete resection of epileptic tissue (frontal corticectomy and prefrontal lobectomy) and are seizure-free. Two underwent partial resection (lateral temporal lobectomy, frontal corticectomy with anterior callosotomy) and have experienced a significant reduction in seizure frequency. Surgery did not result in any significant neurologic deficit or lead to compromise of developmental status. From these data, we tentatively conclude that excisional surgery can be performed safely in selected infants with medically uncontrolled malignant partial seizures and may significantly improve long-term seizure status. Referral to a tertiary center specializing in early childhood epilepsy surgical evaluation may be considered in these circumstances.