Epilepsy surgery in the first 3 years of life: a Canadian survey.
OBJECTIVE
To determine the clinical characteristics, surgical challenges, and outcome in children younger than 3 years of age undergoing epilepsy surgery in Canada.


METHODS
Retrospective data on patients younger than age 3 years who underwent epilepsy surgery at multiple centers across Canada from January 1987 to September 2005 were collected and analyzed.


RESULTS
There were 116 patients from eight centers. Seizure onset was in the first year of life in 82%, and mean age at first surgery was 15.8 months (1-35 months). Second surgeries were done in 27 patients, and a third surgery in 6. Etiologies were malformations of cortical development (57), tumor (22), Sturge-Weber syndrome (19), infarct (8), and other (10). Surgeries comprised 40 hemispheric operations, 33 cortical resections, 35 lesionectomies, 7 temporal lobectomies, and one callosotomy. There was one surgical mortality. The most common surgical complications (151 operations in 116 patients) were infection (17) and aseptic meningitis in 13. Of 107 patients with seizure outcome assessed more than one year postoperatively, 72 (67.3%) were seizure free (Engel I), 15(14%) had >90% improvement (Engel II), 12 had >50% improvement (Engel III), and 8 did not benefit from surgery (Engel IV). Development improved in 55.3% after surgery.


CONCLUSIONS
Epilepsy surgery in children younger than 3 years of age is relatively safe and is effective in controlling seizures. Very young age is not a contraindication to surgery in children with refractory epilepsy, and early surgery may impact development positively.
Steinbok
Paul
P
Divisions of Neurosurgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada. psteinbok@cw.bc.ca
Gan
Peter Y C
PY
Connolly
Mary B
MB
Carmant
Lionel
L
Barry Sinclair
D
D
Rutka
James
J
Griebel
Robert
R
Aronyk
Keith
K
Hader
Walter
W
Ventureyra
Enrique
E
Atkinson
Jeffrey
J
D000367:Age Factors; D002170:Canada; D002675:Child, Preschool; D004827:Epilepsy / Q000145:classification / Q000209:etiology / Q000601:surgery*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000145:classification / Q000379:methods*; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome