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Published on: May 20, 2016
Epilepsy surgery in infants up to 3 months of age: Safety, feasibility, and outcomes: A multicenter, multinational
Jonathan Roth1, Shlomi Constantini1, Margaret Ekstein2
1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Insights
Ultra-early epilepsy surgery before 3 months of age offers excellent seizure control for drug-resistant epilepsy (DRE) in infants. This aggressive approach, when performed by experienced teams, shows comparable safety to surgery in older infants, supporting its use.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Drug-resistant epilepsy (DRE) in infants presents significant challenges, often stemming from extensive developmental anomalies.
- Surgical intervention is frequently necessary but data on
- ultra-early
- epilepsy surgery (before 3 months) is limited.
Purpose of the Study:
- To evaluate the safety and efficacy of ultra-early epilepsy surgery performed in infants under 3 months of age.
- To analyze seizure outcomes and complications in this specific pediatric population.
Main Methods:
- A multinational, multicenter retrospective study was conducted.
- Data from 64 infants undergoing 69 surgeries before 3 months of age were analyzed, focusing on epilepsy characteristics, surgical details, outcomes, and complications.
Main Results:
- The most common pathologies included cortical dysplasia, hemimegalencephaly, and tubers.
- Excellent epilepsy outcome (ILAE grade I) was achieved in 66% of cases at a median follow-up of 41 months.
- No perioperative deaths or major unexpected permanent morbidities were observed; 25% of patients undergoing hemispheric surgeries developed hydrocephalus.
Conclusions:
- Ultra-early epilepsy surgery is associated with excellent seizure control in infants with DRE.
- When performed by experienced teams, this surgery demonstrates a safety profile comparable to that in older infants.
- Age should not be a deterrent for considering surgical treatment in very young infants with DRE.
Objective:
Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on "ultra-early" epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months.
Methods:
To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications.
Results:
Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p < .0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections).
Significance:
Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.
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