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Updated: Jul 23, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Epilepsy surgery in early infancy: A retrospective, multicenter study
Konstantin L Makridis1,2,3,4, Kerstin Alexandra Klotz5, Georgia Ramantani6,7,8
1Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Insights
Early epilepsy surgery in infants can achieve good seizure control and improve development, but carries risks. Surgery should only be performed in specialized centers due to potential complications.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Epilepsy surgery offers a cure for lesional drug-resistant epilepsy (DRE).
- Infants are often hesitant to undergo surgery due to complication fears.
- Limited data exists on surgical complications and cognitive outcomes in infants.
Purpose of the Study:
- To evaluate the safety and efficacy of early epilepsy surgery in infants.
- To assess seizure control and neurodevelopmental outcomes post-surgery.
- To identify risks associated with epilepsy surgery in the first six months of life.
Main Methods:
- Retrospective multicenter study of 15 infants undergoing epilepsy surgery within the first six months of life.
- Median age at surgery was 134 days; most common cause was cortical malformation.
- 13 patients underwent hemispherotomy; two-thirds required blood transfusions.
Main Results:
- 57% seizure freedom at a median 1.5-year follow-up; 79% after reoperation.
- Two severe intraoperative complications, including one death.
- Two-thirds of patients had reduced anti-seizure medications; all showed developmental improvement.
Conclusions:
- Early epilepsy surgery in infants can lead to significant seizure reduction and developmental gains.
- Perioperative risks necessitate careful consideration and management.
- Surgery should be exclusively conducted in specialized pediatric epilepsy centers.
Abstract:
Although epilepsy surgery is the only curative therapeutic approach for lesional drug-resistant epilepsy (DRE), there is reluctance to operate on infants due to a fear of complications. A recent meta-analysis showed that epilepsy surgery in the first 6 months of life can achieve seizure control in about two thirds of children. However, robust data on surgical complications and postoperative cognitive development are lacking. We performed a retrospective multicenter study of infants who underwent epilepsy surgery in the first 6 months of life. 15 infants underwent epilepsy surgery at a median age of 134 days (IQR: 58) at four centers. The most common cause was malformation of cortical development, and 13 patients underwent a hemispherotomy. Two thirds required intraoperative red blood transfusions. Severe intraoperative complications occurred in two patients including death in one infant due to cardiovascular insufficiency. At a median follow-up of 1.5 years (IQR: 1.8), 57% of patients were seizure-free. Three patients where reoperated at a later age, resulting in 79% seizure freedom. Anti-seizure medication could be reduced in two thirds, and all patients improved in their development. Our findings suggest that early epilepsy surgery can result in good seizure control and developmental improvement. However, given the perioperative risks, it should be performed only in specialized centers.
