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Published on: August 16, 2024
Epilepsy surgery in children under 3 years of age: surgical and developmental outcomes
Masaki Iwasaki1, Keiya Iijima1, Takahiro Kawashima2
11Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo.
Insights
Early pediatric epilepsy surgery offers a favorable risk-benefit profile for infants with refractory epilepsy. Achieving seizure freedom post-surgery is crucial for positive developmental outcomes in children.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Neuroscience
Background:
- Infantile epilepsy, often caused by cortical dysplasia like hemimegalencephaly, necessitates early surgical intervention.
- While effective, pediatric epilepsy surgery in infancy has not been thoroughly characterized regarding its developmental impact and complication rates.
Purpose of the Study:
- To evaluate the risk-benefit balance of early pediatric epilepsy surgery.
- To assess the impact of early surgical intervention on developmental outcomes in infants.
Main Methods:
- Retrospective analysis of 75 patients under 3 years old undergoing their first epilepsy surgery (2006-2019).
- Collected data on surgical complications, seizure control, and developmental quotient (DQ) with at least 1-year follow-up.
- Utilized multiple regression to identify factors influencing 1-year postoperative DQ.
Main Results:
- 82.7% of patients achieved seizure freedom at 1 year post-surgery; 71.0% at mean 62.8 months follow-up.
- 17.3% experienced complications requiring cerebrospinal fluid (CSF) diversion surgery (e.g., hydrocephalus).
- Postoperative DQ was significantly influenced by preoperative DQ and seizure freedom, not surgical complications.
Conclusions:
- Early pediatric epilepsy surgery presents an acceptable risk-benefit ratio for infants.
- Postoperative seizure control is a key determinant of favorable developmental trajectories in young children.
Objective:
Pediatric epilepsy surgery is known to be effective, but early surgery in infancy is not well characterized. Extensive cortical dysplasia, such as hemimegalencephaly, can cause refractory epilepsy shortly after birth, and early surgical intervention is indicated. However, the complication rate of early pediatric surgery is significant. In this study, the authors assessed the risk-benefit balance of early pediatric epilepsy surgery as relates to developmental outcomes.
Methods:
This is a retrospective descriptive study of 75 patients who underwent their first curative epilepsy surgery at an age under 3 years at the authors' institution between 2006 and 2019 and had a minimum 1-year follow-up of seizure and developmental outcomes. Clinical information including surgical complications, seizure outcomes, and developmental quotient (DQ) was collected from medical records. The effects of clinical factors on DQ at 1 year after surgery were evaluated.
Results:
The median age at surgery was 6 months, peaking at between 3 and 4 months. Operative procedures included 27 cases of hemispherotomy, 19 cases of multilobar surgery, and 29 cases of unilobar surgery. Seizure freedom was achieved in 82.7% of patients at 1 year and in 71.0% of patients at a mean follow-up of 62.8 months. The number of antiseizure medications (ASMs) decreased significantly after surgery, and 19 patients (30.6%) had discontinued their ASMs by the last follow-up. Postoperative complications requiring cerebrospinal fluid (CSF) diversion surgery, such as hydrocephalus and cyst formation, were observed in 13 patients (17.3%). The mean DQ values were 74.2 ± 34.3 preoperatively, 60.3 ± 23.3 at 1 year after surgery, and 53.4 ± 25.1 at the last follow-up. Multiple regression analysis revealed that the 1-year postoperative DQ was significantly influenced by preoperative DQ and postoperative seizure freedom but not by the occurrence of any surgical complication requiring CSF diversion surgery.
Conclusions:
Early pediatric epilepsy surgery has an acceptable risk-benefit balance. Seizure control after surgery is important for postoperative development.
