Surgery for catastrophic localization-related epilepsy in infants

Cortical resection or hemispherectomy has been reported to result in cessation or dramatic reduction of seizures for small numbers of highly selected infants with severe, intractable epilepsy and developmental delay. However, identification of potential surgical candidates during infancy can be especially challenging because seizure semiology and EEG may sometimes give limited localizing information, e.g., in patients with infantile spasms and hypsarrythmia due to focal cortical dysplasia or a tumor. In infants as well as older patients, the location of a potentially resectable epileptogenic lesion must be defined by convergence of results from video EEG, anatomic and functional neuroimaging, and clinical examination. Reported outcomes after surgery in small series include 78% of 23 infants seizure-free or with at least 90% seizure reduction (1993 University of California at Los Angeles series), and 75% of 12 infants seizure-free or with rare seizures (1995 Cleveland Clinic series). A tendency of "catch-up" developmental progress after surgery was observed in both series. A few reports of smaller groups of infants noted similar results. Prospective studies are in progress to better define the potential risks and benefits of early surgical intervention for infants and catastrophic localization-related epilepsy.