Invasive explorations in children younger than 3 years.

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epileptology

Background:

• Drug-resistant focal epilepsy in young children (under 3 years) presents diagnostic challenges due to evolving neurophysiology and imaging limitations.
• Surgical candidacy often necessitates invasive exploration, but its use in this age group remains debated due to perceived risks and feasibility concerns.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of invasive neurophysiological exploration in children under 3 years with drug-resistant focal epilepsy.
• To determine the diagnostic yield and surgical outcomes following invasive exploration in this specific pediatric population.

Main Methods:

• Retrospective analysis of 26 children under 3 years who underwent invasive exploration for drug-resistant epilepsy between 2000 and 2009.
• Review of clinical, neuroimaging (MRI), and electrophysiological data, including post-operative outcomes for those who proceeded to surgery.
• Utilized subdural electrodes and stereo-electro-encephalography (SEEG) based on age, with SEEG being more challenging before age 2.

Main Results:

• Invasive exploration was feasible and well-tolerated, with a low morbidity rate (3%).
• Seventeen out of 25 surgically treated children (68%) achieved Engel class 1 outcome (seizure freedom).
• Focal cortical dysplasia was the most common histopathological finding (21 cases).

Conclusions:

• Invasive neurophysiological exploration is a safe and effective procedure for drug-resistant lesional epilepsy in children under 3 years.
• It is indicated in cases of drug-resistant lesional epilepsy with developmental delay, offering better lesion delineation than MRI alone.
• The choice of invasive technique is age-dependent, and its indication should be considered similarly to older children.