Epilepsy surgery in the first three years of life.
OBJECTIVE
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.
Duchowny
M
M
Neuroscience Program and the Comprehensive Epilepsy Center, Miami Children's Hospital, Florida 33155, USA.
Jayakar
P
P
Resnick
T
T
Harvey
A S
AS
Alvarez
L
L
Dean
P
P
Gilman
J
J
Yaylali
I
I
Morrison
G
G
Prats
A
A
Altman
N
N
Birchansky
S
S
Bruce
J
J
D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019690:Technetium Tc 99m Exametazime