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Developmental outcome in infancy after epilepsy surgery and its associated factors: A systematic review and
Fandi Hendrawan1, Ofadhani Afwan1, Patricia Alika Kurniawan1
1Faculty of Medicine, Nursing, and Public Health Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia.
Insights
Epilepsy surgery did not significantly change developmental quotients in infants with pharmacoresistant epilepsy (PRE). Achieving a seizure-free state after surgery is vital for infant development, though not always possible.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Surgical Neurology
Background:
- Pharmacoresistant epilepsy (PRE) in infancy presents significant challenges to neurodevelopment.
- Epilepsy surgery is a potential intervention, but its impact on developmental outcomes requires thorough investigation.
Purpose of the Study:
- To systematically evaluate the effect of epilepsy surgery on the developmental quotient (DQ) in infants with PRE.
- To identify factors associated with developmental outcomes following epilepsy surgery in this population.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Literature search across PubMed, CENTRAL, and Scopus databases; risk of bias assessed using ROBINS-I.
- Developmental outcome assessed by comparing pre- and post-surgery DQ; meta-regression explored influencing factors.
Main Results:
- Ten studies involving 361 participants were included.
- Overall meta-analysis showed no significant change in DQ post-surgery (MD -2.38; 95% CI -5.53–0.78).
- No significant difference in DQ change was observed between seizure-free and non-seizure-free groups; no significant moderators identified.
Conclusions:
- Epilepsy surgery may provide benefits for infants with PRE, with many showing stable developmental progress.
- A seizure-free state post-surgery is critical for optimal infant development.
- Palliative surgery for seizure control should be considered when epileptogenic lesions are not amenable to complete resection.
Objective:
To investigate the impact of epilepsy surgery on the developmental outcome in infancy with pharmacoresistant epilepsy and its associated factors.
Method:
This systematic review and meta-analysis was conducted in adherence with PRISMA 2020. Literature searching was done using PubMed, CENTRAL, and Scopus database. The risk of bias within included studies was evaluated using ROBINS-I. The developmental outcome was explored by comparing the developmental quotient (DQ) between before and after the epilepsy surgery. The subgroup analysis was planned for sex, etiology, affected side, affected lobe, surgical method and intention, and seizure-free state after the surgery. Age at onset of epilepsy, age at surgery, duration of disease, and follow-up time were explored as well in meta-regression.
Result:
Ten articles were included in this review yielded 361 participants. The overall meta-analysis did not show a significant change of DQ after the surgery (MD -2.38; 95%CI -5.53 - 0.78). The comparison of delta DQ between seizure-free and not seizure-free population was not significantly different (seizure-free group; MD -4.33; 95%CI -20.37 - 11.70 vs. non-seizure-free group; MD -4.34; 95%CI -16.22 - 7.54). No independent significant moderator was identified.
Conclusion:
Epilepsy surgery may offer some benefits in infants with PRE despite most participants having stable developmental progress. Seizure-free state following epilepsy surgery is crucial for infants' development; however, not all epileptogenic lesions are located in the favourable and resectable area. Hence, seizure control with palliative surgery shall be offered.
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