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Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy
Ramesh M Kumar1, Susan Koh, Kelly Knupp
1Department of Neurosurgery, University of Colorado, Denver, CO, USA.
Insights
Early epilepsy surgery in infants with catastrophic epilepsy can lead to excellent seizure control and medication reduction. Despite common complications, young age should not prevent surgical consideration for these challenging cases.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Infants with epilepsy often face severe outcomes.
- Early surgical intervention is often avoided due to perceived risks.
- Characterizing efficacy and safety in infants is crucial.
Purpose of the Study:
- To evaluate the effectiveness of epilepsy surgery in infants.
- To assess the safety and complication rates of early surgical intervention.
- To inform clinical decisions regarding surgical treatment for infant epilepsy.
Main Methods:
- Retrospective review of epilepsy surgeries in children under 1 year old (2002-2013).
- Analysis of demographic data, epilepsy types, surgical techniques, outcomes, and complications.
- Inclusion of patients with daily seizures and abnormal MRI findings.
Main Results:
- Eighty percent of patients achieved seizure freedom post-surgery.
- Forty percent were able to discontinue anticonvulsant medications.
- Common pathologies included focal cortical dysplasia and hemimegalencephaly; 36% experienced complications, including hydrocephalus.
Conclusions:
- Early epilepsy surgery offers excellent outcomes for infants with catastrophic, localization-related epilepsy.
- Complications are frequent, and diagnosis can be complex in this population.
- Infants with severe epilepsy should be considered for early surgical treatment regardless of age.
Purpose:
Infants with epilepsy often have a catastrophic course. There is a reluctance to operate in the very young, due to the perception of an unacceptable risk of morbidity with early operations. The purpose of this investigation was to better characterize the efficacy and safety of epilepsy surgery in infants.
Methods:
Epilepsy operations performed on children under 1 year old, between 2002 and 2013, were reviewed for demographic information, epilepsy characteristics, surgical approach, outcomes, and surgical complications.
Results:
Twenty-five patients, ages 11 days to 11.5 months (mean 4.7) at operation, were identified. All had daily seizures. Twenty-two (88%) had an abnormal magnetic resonance imaging (MRI). Sixteen (64%) patients underwent hemispherotomy at initial operation. Seven (28%) infants had grid placement followed by focal resection. Focal cortical dysplasia was the most common pathology (40%) followed by hemimegalencephaly (32%). Complications occurred in 36% of patients. These included hydrocephalus in five patients (20%). Two patients had significant intra-operative complications which required unplanned staging of their operations. Both recovered without permanent injury. Mean follow-up was 62.4 months. Twenty patients (80%) are seizure-free, and 10 (40%) are off anticonvulsant medication. Two patients are Engel class 2, and the remaining three patients were Engel class 4, one of whom died with status epilepticus from the contralateral hemisphere.
Conclusion:
Infants with localization-related catastrophic epilepsy can have excellent outcomes from early epilepsy surgery. Complications are common in this patient group and proper diagnosis can be challenging. Young age should not exclude infants with catastrophic epilepsy from consideration for early surgical intervention.
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