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Epilepsy surgery in the first three years of life
M Duchowny1, P Jayakar, T Resnick
1Neuroscience Program and the Comprehensive Epilepsy Center, Miami Children's Hospital, Florida 33155, USA.
Insights
Cortical resection can effectively treat catastrophic partial seizures in infants, leading to seizure freedom in many cases. However, this surgery does not guarantee improved neurological development in young children.
Area of Science:
- Pediatric Neurology
- Epilepsy Surgery
- Infantile Seizures
Background:
- Infantile partial seizures can have severe long-term consequences.
- Epilepsy surgery is established for older patients, but data for infants is limited, except for hemispheric epilepsy.
Purpose of the Study:
- To evaluate the efficacy of cortical resection for medically refractory partial epilepsy in children under three years old.
- To assess the impact of epilepsy surgery on seizure control and neurological development in infants.
Main Methods:
- Retrospective analysis of 31 children under 3 years old undergoing cortical resection for medically refractory partial epilepsy.
- Inclusion criteria required seizure relief as the primary surgical indication.
Main Results:
- 26 patients with at least 1-year follow-up showed seizure freedom in 16, >90% reduction in 4, and <90% reduction in 6.
- Favorable seizure outcome correlated with the presence of a discrete lesion on preoperative imaging, not the extent or location of resection.
- Developmental assessments did not confirm perceived developmental acceleration in seizure-free patients.
Conclusions:
- Cortical resection is a beneficial treatment for very young children with catastrophic partial seizures.
- Complete removal of the epileptogenic zone and lesion is key; extent and location of resection may be less critical for seizure outcome.
- While seizure control is often achieved, epilepsy surgery in infancy does not ensure enhanced neurological development.
Purpose:
Partial seizures in early postnatal life may be catastrophic and associated with poor long-term outcome. Epilepsy surgery can alleviate partial seizures in older children and adults, but there is little experience with surgical therapy in infancy apart from hemispheric epilepsy syndromes.
Methods:
We analyzed the results of cortical resection to treat medically refractory partial epilepsy in 31 children (16 boys, 15 girls) aged <3 years (mean, 18.3 months). Subjects were included only if seizure relief was the primary indication for surgery.
Results:
Follow-up of at least 1 year (mean, 4.6 years) in 26 patients revealed that 16 were seizure-free, 4 had >90% seizure reduction, and 6 had <90% reduction. There was no significant difference in seizure outcome between hemispherectomy/multilobar resections and lobar resections or temporal versus extratemporal resection. Seizure outcome was independent of the amount of cortex removed in nonlesional patients. Only the presence of a discrete lesion on preoperative neuroimaging correlated with a favorable outcome. Family perceptions of accelerated development in seizure-free patients were not confirmed on developmental assessment.
Conclusions:
We conclude that cortical resection often benefits very young children with catastrophic partial seizures, but does not guarantee enhanced neurological development. The location and extent of the excised cortex may not be critical as long as the entire epileptogenic region and lesion are removed.