title: Seizure and cognitive outcomes of epilepsy surgery in infancy and early childhood.
abstract: OBJECTIVE
  To investigate seizure and developmental outcomes following epilepsy surgery in very young children and determine their predictive factors.
  
  
  METHODS
  We retrospectively reviewed the clinical data, surgical variables, and outcomes of 30 children under 3 years of age that underwent resection for refractory focal epilepsy in our institution in 2001-2011.
  
  
  RESULTS
  Seizure onset was in the first year of life in 27 (90%) cases and mean age at surgery was 20 months (range 5-33.6). Pathology consisted of cortical malformations in 24 (80%) cases, glioneuronal tumour and infarction with or without cortical dysplasia in three (10%) cases each. Morbidity was comparable with older paediatric cohorts. At 1-11.6 year follow-up (mean 4.1) 21 of 30 (70%) children achieved seizure freedom (Engel I), six (20%) demonstrated worthwhile improvement (Engel II/III) and three (10%) did not benefit from surgery (Engel IV). Intralobar lesionectomy more often resulted in seizure freedom than multilobar or hemispheric surgery. The abundance of non-regional interictal and ictal EEG findings did not preclude seizure freedom. Presurgical developmental impairment was established in 25 of 28 (89%) children; its severity correlated with longer epilepsy duration and determined postoperative developmental outcome. Developmental progress was established in 26 out of 28 (93%) children following surgery, showing stabilized trajectories rather than catch-up.
  
  
  CONCLUSIONS
  Resective surgery in very young children is safe and effective in terms of seizure control and developmental progress. Our findings underline the importance of early intervention in order to timely stop seizures and their deleterious effects on the developing brain.
authors.affiliation: Epilepsy Centre, University Hospital Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany. georgia.ramantani@uniklinik-freiburg.de
authors.forename: Georgia
authors.initials: G
authors.lastname: Ramantani
authors.forename: Navah Ester
authors.initials: NE
authors.lastname: Kadish
authors.forename: Karl
authors.initials: K
authors.lastname: Strobl
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.forename: Angeliki
authors.initials: A
authors.lastname: Stathi
authors.forename: Hans
authors.initials: H
authors.lastname: Mayer
authors.forename: Susanne
authors.initials: S
authors.lastname: Schubert-Bast
authors.forename: Gert
authors.initials: G
authors.lastname: Wiegand
authors.forename: Rudolf
authors.initials: R
authors.lastname: Korinthenberg
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stephani
authors.forename: Vera
authors.initials: V
authors.lastname: van Velthoven
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
authors.forename: Thomas
authors.initials: T
authors.lastname: Bast
mesh_terms: D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D018479:Early Intervention, Educational; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cognitive; Development; Epilepsy; FCD; Focal; Hemispherotomy; Outcome; Surgery